Implementation of NHAct (2014), Panacea for Improving Health at the Grassroots



    As specified in Section three(3) of the NHAct 2014, all Nigerians shall be entitled to a Basic Minimum Package of Health Services (BMPHS) irrespective of age, religion, circumstances and domicile or health status.

    The BMPHS for Nigeria shall consist of nine interventions directed against Hypertension, which is the most common cardiovascular condition in Nigeria (prevalence rate is between 22 percent to 28.9 percent), a urinalysis test for Diabetes11, treatment of malaria for all Nigerians, four Maternal Health interventions for pregnant women such as Antenatal care, labour or delivery care,  emergency obstetric/neonatal care, and caesarean section and two interventions for children (curative care and immunization).

    The NHAct sets out the important drivers to guide disbursement of the Basic Health Care Provision Fund (BHCPF). These “Payment Gateways” are in three-fold and it states that 50 per cent (one half) of the Fund shall be disbursed through the National Health Insurance Scheme (NHIS) and deployed towards the provision of the BMPHS in eligible primary or secondary health care facilities; 45 per cent of the Fund shall be disbursed through the National Primary Health Care Development Agency (NPHCDA) and deployed to strengthening Primary Healthcare Centres (PHCs) in eligible primary healthcare facilities (essential drugs, vaccines and consumables; provision and maintenance of facilities, equipment and transport; development of human resources); and Five  per cent of the Fund shall be disbursed through a Committee appointed by the National Council on Health (NCH) and deployed towards emergency medical treatment.

    According to Sections 3 and 11 of the NHAct, the PHCs shall  be the foundational basis for the provision of healthcare services in Nigeria and in accordance with the act, the current administration has also, in setting out its healthcare agenda, centred it around the provision of functional primary healthcare services in all political wards of the federation, with the ultimate objective of ensuring Universal Health Coverage (UHC) for all Nigerians while keying into the BHCPF to achieving this agenda as well as increasing the fiscal space for health in Nigeria.

    The BHCPF which was established under Section 11 of the NHAct, creates the fiscal space for funding the BMPHS, of which the BHCPF would be financed from federal government annual grant of not less than one percent of Consolidated Revenue Fund, grants from International partners and funds from any other source.

    To ensure judicious use of the funds, the BHCPF guidelines have been developed. The guidelines define the basis for administration, disbursement, monitoring and financial management of the BHCPF. They set out the processes to be applied and the responsibilities of various stakeholders.

    The guidelines stated that the BHCPF will pay for BMPHS through the National Health Insurance Scheme (NHIS); provide operating budgets to PHCs via electronic transfer and then set aside a small portion for dealing with emergencies, including disease outbreaks and road traffic accidents.

    A management secretariat that comprises representatives of a diverse set of stakeholders including states, civil society, private providers, development partners, NHIS, and the NPHCDA will provide oversight for the BHCPF.

    The overriding objective in the development of these guidelines was ensuring efficient disbursement of the Fund to services, which catalyse improved health outcomes. This will be achieved, initially (in the first five years) through the targeting of specific areas of concern including Maternal and child Health and selected Non-Communicable Diseases (NCDs), Road Traffic Injuries (RTIs) and other public health emergencies.

    These guidelines, according to the Honourable Minister of Health, Professor Isaac Adewole, have been painstakingly articulated and employ innovative public and private sector led processes.

    Adewole said, “I have the strong conviction that results from the successful implementation of the provisions of the guidelines will no doubt set Nigeria on track towards accelerating UHC.

    “This document will be regularly reviewed in line with emerging clinical and fiscal developments including best practices that will emerge from its implementation. It is therefore my desire that all actors in the health sector adequately support the implementation of the guidelines for the benefit of every Nigerian. I therefore recommend the guidelines to all stakeholders for appropriate Implementation of the BHCPF.”

    No doubt, the implementation of the NHAct (2014) will bring great transformation to the health care system in Nigeria, and everything that can make the NHAct (2014) work have been put in place. Stakeholders who spoke with LEADERSHIP are calling on the federal government to implement the act and allocate the grant of not less than one percent of Consolidated Revenue Fund in the 2017 budget.

    Former governor, Cross River state, Mr. Donald Duke, in an exclusive interview with LEADERSHIP advocated that the NHAct should be implemented as it is the only last hope of the poor in the country in accessing adequate health care.

    Duke said, “Until Nigeria localizes medicine, making medical services available within commmunities, the country will not get it right. Ultimately, we need to have medical insurance, we need to ensure that whether a citizen has a job or not, his/her health is not compromised. I think Nigeria has the intelligence to make it work.”

    In the same vein, The Vice President, Prof. Yemi Osibajo, at a stakeholder’s meeting involving key players in the health sector towards scaling up innovative solutions for efficient health care systems recently in Abuja stressed the need for a comprehensive NHIS to ensure quality healthcare delivery to all Nigerians.

    Osinbajo however called for public private partnership (PPP) for effective healthcare delivery in Nigeria.

    He said, “A comprehensive NHIS is needed to ensure quality healthcare delivery to the citizenry but government cannot finance healthcare from public funds alone hence the participation of the private sector was pertinent.”

    Senator Olanrewaju Tejuoso, representing Ogun Central at the National Assembly, at the senate plenary hearing on the 2017-2019 medium term expenditure framework expressed shock over the non implementation of the NHAct (2014).

    Tejuoso however recommended that the senate should look into the act and see how it can be implemented in the 2017 health budget.


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