Implementing The National Health Act

The National Health Act was made as an a law to provide a legal framework for the regulation, development and management of a National Health System and to set standards for rendering health services in the Federation and for related matters. The National Health System established under the Act has as part of its objectives the protection, promotion and fulfilment of the right of Nigerians to have access to health care services as it seeks to provide for persons living in Nigeria, the best possible health services within the limits of available resources. These provisions of the Act are in tandem with Nigeria’s treaty obligations (especially, under the International Covenant on Economic, Social and Cultural Rights) to take steps, to the maximum of available resources, with a view to achieving progressively the full realisation of the right to health.

The Act made a number of provisions which potentially will improve Maternal, New Born and Child Health. These include the mandate of the Federal Ministry of Health under Section 2 (2) to prepare strategic medium term health and human resource plans annually for the exercise of its powers and the performance of its duties under the Act. The ministry is to ensure that the national health plan forms the basis for budget preparation and other government planning exercise as may be required by law. The National Council established by the Act has a mandate inter alia to ensure that children between the ages of zero and five years and pregnant women are immunised with vaccines against infectious diseases. These provisions reinforce government’s obligation under the Child Rights Act to endeavour to reduce infant and child mortality rate; ensure the provision of necessary medical assistance and health care services to all children with emphasis on the development of primary health care; combat disease and malnutrition within the framework of primary health care through the application of appropriate technology; and ensure appropriate health care for expectant and nursing mothers.

The National Health Act establishes a Basic Health Care Provision Fund with a government annual grant of not less than one per cent of the Consolidated Revenue Fund which is to be used inter alia; 20 per cent for essential drugs, vaccines, and consumables for eligible primary health care facilities; 15 per cent for the provision and maintenance of facilities, equipment and transport for eligible primary health care facilities whilst 10 per cent is to be used for the development of human resources for primary health care. It also makes provisions for grants to state and local governments that will be required to provide counterpart funding of 25 per cent of the total cost of the project. It strengthens the authority of the National Primary Health Care Development Agency over the Local Government Health Authority and it can withhold funds due to the later, if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of the Act.

The 2015 and 2016 federal budgets ignored the provisions of the National Health Act which mandates the provision of not less than 1 percent of the Consolidated Revenue Fund to the Basic Health Care Provision Fund. The authorities indicated that in late 2014, the 2015 budget proposals were already prepared before President Goodluck Jonathan assented to the bill to become law. But since it became law, it was incumbent of the fiscal authorities, on the prompting of the Federal Ministry of Health to amend the budget and reflect the fact of the provisions of the law because a law takes effect from the date it gets assent by the President. If there was an excuse in 2015, the 2016 experience of leaving out the Basic Health Care Provision Fund is inexcusable and is clearly a violation of the law. It needs to be noted that what the law stated is not less than 1 percent of the Consolidated Revenue Fund which is the minimum floor. It could therefore be more than 1 percent.

The implication of the foregoing is that MNCH and related services (using the minimum floor of 1 percent) lost good sums of money. With a total Consolidated Revenue Fund of N3.419tn in 2015, one per cent amounts to N34.190bn which should have been remitted to the Basic Health Care Provision Fund. With a total Consolidated Revenue Fund of N3.855trilion in 2016, one per cent amounts to N38.555bn which should have been remitted to the Basic Health Care Provision Fund. Of these sums, 45 per cent per cent of the Basic Health Care Provision Fund would have gone to the National Primary Health Care Development Agency which would have used it for a number of programmes including the MNCH. This will amount to N15.385bn and17.350bn in 2015 and 2016 respectively; bringing the total to N32.735bn over the two years. Also, the 50 per cent of the Basic Health Care Provision Fund going to basic minimum package of health services to citizens through the National Health Insurance Scheme will have impacted on MNCH.

Nigeria therefore needs to re-programme its priorities in compliance with the Act and ensure that the requisite sum is provided in the 2017 federal budget.