Nigeria’s New Health Law, and the Right to a Responsive Healthcare System Amidst a Dysfunctional One
On 9 December 2014, President Goodluck Jonathan signed into law Nigeria’s first ever Health Act. Not surprisingly, this has been widely celebrated by stakeholders across the country and the diaspora as an important milestone for the health sector of Nigeria. The coming on board of this legislation brings to an end close to a decade of activism by stakeholders in the health sector of the country. It now appears that finally an answer to the cry of many Nigerians for critical reform in the health sector has been provided – or is that really the case?
To put things in perspective, Nigeria has one of the poorest performing healthcare systems on the African continent. This is the image that globally recognised indicators of a functional healthcare delivery system portray of Nigeria’s healthcare infrastructure. This is the case despite the much touted accomplishment in curbing the spread of the Ebola Virus; in point of fact Nigeria’s success in this instance was an accident of good fortune that could have gone awry if the peculiar circumstances of the time were any different – a narrative for another time. Regardless of the amount of praise lavished on the government’s effort, an effort that remains commendable, the success recorded in curbing the Ebola Virus in Nigeria cannot serve as a good indicator of the situation of Nigeria’s healthcare system.
There are several indicators used to measure the performance of health systems globally. International institutions like the WHO, UNICEF, UNDP and World Bank have each developed indicators for assessing the performance of health systems. Going by many of these indicators, Nigeria’s health system is among the poorest performing ones on the African continent. To provide an instance, the WHO proposed eight Millennium development goals at the Millennium Summit of 2000. Out of these eight goals, three are health-related, namely: reduction in infant and under-five mortality rate by two-thirds from what it was in 1990; improvement in maternal mortality from the situation in 1990; and combatting HIV/AIDS, Malaria and other Diseases. The global community committed to the attainment of these goals by 2015. It is now 2015 and the datasets for Nigeria are not good.
In the area of infant mortality data provided by WHO indicate that although there was some reduction in the rate of infant deaths, from the 1990 situation of 213 infant deaths per 1000 live births to the current situation of 124 deaths by 1000 live births, the MDG goal of a two-third reduction (which requires further reductions to 71 deaths per 1000 live births) has not been met. What this means is that the health system has failed to meet the UN Millennium goals the country signed on to.
With respect to the goal of improvement in maternal health, two main indicators are set up to measure its attainment, namely: reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio (measured per 100,000 live births); and achieve universal access to reproductive health. With respect to the first indicator, in 1990 the rate of maternal mortality was 1200 deaths per 100,000 live births. At the moment, the figure has reduced to 560 deaths per 100,000 live births. But it is still far above the MDG target (which requires it to reduce to 300 deaths per 100, 000 live births).
The final indicator deals with combatting HIV/AIDS, Malaria and other Diseases and maps out targets to be attained for each of these diseases. Suffice it to say that none of the targets has been met (or are likely to be met) in view of the fact that we are already in 2015.
It is on the basis of these indicators, and several others which I have not bothered to go into – such as the situation of health financing in the country measured against international minimum standards – that informed the conclusion that Nigeria’s healthcare system is not performing as it ought to be. I have not touched on the most obvious aspects of the healthcare system such as the egregious levels of dilapidation of hospitals and clinics in the country; poor access to healthcare; inequity in the distribution of healthcare facilities and personnel; poor or no health insurance coverage for millions of Nigerians, etc – these are issues that severely impact the performance of any healthcare system, and on which Nigeria is performing below expectation.
There are a number of conclusions that can be reached on what the problem seems to be; I have, in this instance, drawn these conclusions after carefully studying the healthcare delivery system in Nigeria. Some of my conclusions have lead me to question whether the new health legislation which Mr. President signed into law holds the answer to the myriad challenges confronting the country’s healthcare system or whether a lot more needs to be done going forward.