COVID-19, Certificate of Standards and Medical Tourism

Eze Onyekpere

The COVID-19 pandemic has put the right to health on the front burner of global discourse. Virtually every person wakes up, talks about, meditates and dreams of health issues, especially the COVID-19 pandemic. Within the Nigerian context, the pandemic has thrown health to the front burner while raising a lot of other associated developmental challenges. It appears that we were not prepared to face the pandemic and the implementation of the National Health Act, enacted over six years ago, which would have prepared us for health emergencies and challenges was neglected and the provisions obeyed in the breach. This discourse reviews a few provisions of the Act that resonate with the current pandemic.

The Act in sections 13 and 14 state as follows: “13. (1) Without being in possession of a Certificate of Standards, a person, entity, government or organisation shall not :- (a) establish, construct, modify or acquire a health establishment, health agency or health technology; (b) increase the number of beds in, or acquire prescribed health technology at a health establishment or health agency; (c) provide prescribed health services; or (d) continue to operate a health establishment, health agency or health technology after the expiration of 24 months from the date this Bill took effect. (2) The Certificate of Standards referred to in subsection (1) of this section may be obtained by application in prescribed manner from the appropriate body of government where the facility is located. In the case of tertiary institutions, the appropriate authority shall be the National Tertiary Health Institutions Standards Committee, acting through the Federal Ministry of Health. 14. Any person, entity, government or organisation who performs any act stated under section 13 (1) without a Certificate of Standards required by that section is guilty of an offence and shall be liable on conviction to a fine of not less than N500,000.00 or in the case of an individual, to imprisonment for a period not exceeding two years or both”.

Six years after the commencement of the Act, the Ministry of Health has failed, refused and neglected to set the machinery in motion for the assessment of health institutions and the issuance of the certificate of standards. Stricto sensu, under Nigerian law, all health establishments operating in Nigeria, from the teaching hospital to the primary health care centre, are operating illegally. It has been over 64 months since the Act came into force, which is much more than the 24 months of commencement prescribed by the Act. If this provision of the Act had been implemented to the letter, over 80 per cent of our health institutions would have failed to secure accreditation and would have been denied the certificate of standards. The implication would have been manifest on two fronts. The first is that the institutions would have been closed so that they are stopped from rendering substandard services and the second would have crystallised government’s obligation to fund the establishments. Where the establishments are privately owned, the owners would also be compelled to adequately provide funds to ensure that they meet the requisite standards. Definitely, there would have been a pushback from the populace for the government to fund the establishments if so many of them failed the assessment.

If the available health establishments had been assessed in accordance with the law and duly certificated, we would have had establishments with the requisite human resources, equipment, drugs, accessories, funding and management to mount an effective push back to any pandemic. Technically, the country is due to collect the sum of N500,000 fine per health establishment multiplied by the number of uncertificated establishments in the country. The accruing money will be in the billions of naira.

The second provision is Section 46 of the Act which provides that: “Without prejudice to the right of any Nigerian to seek medical check-up, investigation or treatment anywhere within and outside Nigeria, no public officer of the Government of the Federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation or referral shall be duly approved by the Minister or the Commissioner as the case may be”. Public confidence in the Nigerian health system is low. Many rich Nigerians and even those in the middle- and low-income groups spend huge resources to travel abroad for medical treatment. The reasons for medical tourism include ill-equipped hospitals and facilities and absence of requisite medical skills and competencies for the treatment of some health conditions. So many years after the Act came into force, so many public officers travel abroad at the public expense for medical treatment even for ordinary malaria and for non-complicated ill-health that can be treated locally.

Pray, was the procedure prescribed in Section 46 of the Act followed when the President, Major General Muhammadu Buhari (retd.) and many other public officers travelled abroad for medical treatment? Now, without going through the niceties of citing the Act, the pandemic has enforced this provision to the letter and in fact, the enforcement is a blanket one as it has even ruled out the recommendation and referral of the medical board and the approval of the minister or commissioner for health. None of them is valid before the pandemic. If this provision had been enforced to the letter, our health institutions would have been better equipped with human and material resources because the political authorities would have had personal interests to invest in the Nigerian health system. Budgetary allocations would not have been below five per cent as has been the case while actuals in terms of released, cash-backed and utilised sums would have been higher. We would have been inching towards a budget of 15 per cent based on the mandate of fit and good practices.

The private sector and citizens follow the lead of their government. If health establishments had passed through the certification process and more resources had been invested in a value for money approach in Nigerian health establishments, private citizens would also have no need for medical tourism. They would patronize the local health establishments thereby conserving over $2billion projected as lost to medical tourism every year from Nigeria. Well-equipped and funded health establishments would also have kept many of our health professionals who have left the country for greener pastures back home, thereby increasing the pool of human resources from which we can draw on in the case of a pandemic like the current one. Many health professionals left the country not just for bigger pay checks, but also to derive greater job satisfaction which comes from working in a conducive environment that has the requisite equipment and where they human input is appreciated.

It is therefore imperative for Nigerians to come together and make massive demands for the full implementation of all the key provisions of the Act in view of the challenges which this pandemic has thrown up. There is no better time to demand the improvement of the health system than now.