National Health Act abrogates Police report in medical emergencies

President Goodluck Jonathan recently signed the new national health bill into law. The law addressed the controversial police report usually demanded by health institutions before attending to gunshot victims. JOSEPH ONYEKWERE in this report highlights some of the provisions of the new law and notes that it now guarantees victims of auto crashes and violent crimes prompt medical attention.

JUST before the electioneering campaign gathered momentum, President Goodluck Jonathan in December 2014 signed the National Health Act into law. It was a cheery news for Nigerians. 

The new law addresses the problems faced by patients with medical emergencies, in road crashes or victims of armed robberies. Those category of persons are usually in dire need of urgent medical attention but are callously rejected by public and private health institutions, on the ground that a counter-productive Police report must be provided.

    Those whose relations, parents, friends, colleagues or acquaintances have had the ordeal of seeking urgent medical attention under fatal situations understand how gladdening this law is. One of its most beautiful implications is its worthy acknowledgement of human life as something to be accorded utmost care and attention.

    The law provides that there will be no excuse for failure of health services for Nigerians.  It also stipulates severe punishment and imprisonment terms for removal of human organs and also the reproductive and therapeutic cloning of human kind.

    Executive Secretary, Health Sector Reform Coalition (HSRC), a watchdog group on the national health system, Dr. Muhammed Lecky in his reaction to the Act said: “Now that we have the Health care Act, we expect that health services for Nigerians would be transformed”          The truth is that the health care administration in Nigeria is nothing to write home about, irrespective of Obasanjo’s National Health Insurance Scheme – incessant strikes by health care providers and poor facilities had helped to plunge the sector deep into degeneration.

Though belated – coming over 54 years after Nigeria’s sovereign existence as a nation, it is better than none at all and the president and members of the national assembly need commendation .

    Accident/emergency patients were handled with jaw-dropping levity under various excuses. The most common and oppressive of them all is the insistence that an accident victim or emergency patient must provide Police report before they are treated. This includes victims of gunshot wounds who are usually left to die. 

    The beginning of this trend, religiously practised in Nigeria, emanated from the need to apprehend armed robbers or at worst make them die without treatment. The authorities were indeed off the mark in global medical best practices for intending to deny criminals medical attention, therefore prompting medical personnel to avoid subsequent query from the police authorities. 

    The practice in other jurisdictions is that armed robbers wounded during criminal operations, have right to good medical treatment, before they are eventual arraigned, tried and convicted, if found guilty.

   Sadly, Nigeria has lost countless precious lives due to the callous approach to medical emergencies. It is of no use mentioning names but the case of Guardian’s Assistant News Editor, Bayo Ohu murdered in broad day light at his residence in Egbeda, in the Alimosho Local Government Area of Lagos State on Sunday 20 September, 2009 readily comes to mind. 

    Under such grevious emergency, when he was bleeding profusely, a hospital denied him urgent attention on the gound that a Police report must be produced. If only he was attended to promptly, perhaps, he might have survived. The is the lot of  Nigerian’s who are fatally injured in auto crashes, armed robbery attacks and others.

Interestingly,  part 3 of the Act discussed the rights and obligations of users and healthcare personnel.

    Section 20 (1) says a health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason whatsoever.

Subsection (2) says any person who contravenes this section is guilty of an offence and is liable on conviction to a fine of Nl00, 000 or to imprisonment for a period not exceeding six months or to both.

    Section 21(1) states: “Subject to any applicable law, the head of the health establishment concerned may in accordance with any guideline determined by the Minister, Commissioner or any other appropriate authority impose conditions on the services that may be rendered by a healthcare provider or health worker on the basis of health status except if the health personnelclaims a conscientious exemption”. Subsection (2) says subject to any applicable law, every health establishment shall implement measures to

minimise- (a) injury or damage to the person and property of health care personnel working at that establishment; and (b) disease transmission.

    In sub section (3) it says:  “Without prejudice to section 19(1) and except for Psychiatric patients, a health care provider may refuse to treat a user who is physically or verbally abusive or who sexually harasses him or her, and in such a case the health care provider should report the incident to the appropriate authority

    In section 22, the Act says, subject to not being found negligent, a health care provider or other officers or employees of a health care establishment shall be indemnified out of the assets of the health care establishment against any liability incurred by him in defending any proceeding, whether civil or criminal in which judgement is given in his favour or is acquitted, if any such proceeding is brought against him in his capacity as a health care provider, an officer or employee of a health care establishment.

    Section 23 (1) provides that every health care provider shall give a user relevant information pertaining to his state of health and necessary treatment relating thereto including: rights of Health Care Personnel, Indemnity of the HealthCare provider,

Officer or Employee of a Health Care Establishment.

    Another intereating aspect of the Act is the one that relates to user knwoledge. The Act provides that users shall  have full knowledge of what the medics are doing on him. It says: “(a) the user’s health status except in circumstances where there is substantial evidence that the disclosure of the users health status would be contrary to the best interests of the user; (b) the range of diagnostic procedures and treatment options generally available to the user; (c) the benefits, risks, costs and consequences generally associated with each option; and (d) the user’s right to refuse health services and explain the implications, risks, obligations of such refusal. “(2) the health care provider concerned shall, where possible, inform the user in a language that the user understands and in a manner which takes into account the user’s level of literacy.”

    Another striking feature of the Act is the provision for dissemination of comprehensive information about the health care povider. This, it says, can be done by displaying such at the health care facility.

    This is found in section 24. It says: “The Federal Ministry, every State Ministry of Health, every Local Government Health Authority and every private health care provider shall ensure that appropriate, adequate and comprehensive information is disseminated and displayed at facility level on the health services for which they are responsible, which shall include – duty to disseminate information. (a) the types of health services available; (b) the organisation of health services; (c) operating schedules and timetables of visits; (d) procedures for laying complaints and (e) the rights and duties of users and health care providers.”

    Subject to applicable archiving legislation, the Act says any person in charge of a health establishment shall ensure that a health record containing such information as may be prescribed is created and available at that health establishment for every user of health services. There are however, many more praise worthy provisions in the Act. 

    That makes the Act a right step in the right direction. But we hope it will fulfil the expectations of ensuring a truly universal health coverage that would assure and guarantee Nigerians’ fundamental human rights to life and good healthcare. But as it is peculiar to Nigeria, laws are hardly enforced.

    Under this law, it is good to note that children below the age of five, pregnant women, the elderly and people with disabilities would receive free health care.

    The Federal Government is also statutorily expected to provide sufficient complimentary funding, in tandem with states and Local Government Councils across the  country, so as to guarantee basic minimum healthcare for all.

    There is no doubt that this Act has created a legal framework for a new healthcare policy regime. It is fashioned to create proper health focus and guide against  needless bureaucratic bottlenecks.  The Act needs to be implemented in order to jettison the inhuman official attitude of the past.

    The new health law has to do with sanctity of human life; and we (Nigerians) are hopeful that henceforth, there will be undeniable compelling national acceptance of accident and emergency cases by health institutions whether public or private.

    One thing that both the government and industry stakeholders must not fail to do is complement the coming to place of the Act with adequate publicity and awareness campaigns, to make the public know, understand and buy into the programme.  If it is well implemented, Nigeria would surely reap the fruits of a sound health sector reforms.

    The Act furthermore, establishes a National Tertiary Health Institutions Standards Committee. The Committee shall consist of: (a) the Chairman who shall be a person in the health profession with vast knowledge and experience in health service delivery, planning and organization to be appointed by the minister.

    The committee will have representative of the following : (i) Ministry of Finance; (ii) Ministry of Education; and (iii) Office of the Head of Service of the Federation.

It will also have representatives of Chief Executives of Tertiary Hospitals; the Registrars of all health professions regulatory agencies or councils in Nigeria; six persons appointed on merit by the Minister, one from each geographical zone to represent the public interest at least two of whom shall be women; one person to represent the organized private sector; and

the Director, Department of Hospital Services, Federal Ministry of Health who shall be a

member and Secretary of the Committee.

    The law also provides for the creation of fund to be known as Basic Health Care Provision Fund. The Basic Health Care Provision Fund shall be financed from- (a) Federal Government’s Annual Grant of not less than one per cent of its Consolidated Revenue Fund,  grants by international donor partners; and funds from any other source.

Money from the fund shall be used to finance the following:- (a) 50% of the fund shall be used for the provision of basic minimum package of health services to citizens, in eligible primary/or secondary health care facilities through the National Health Insurance Scheme (NHIS). 20 percent of the fund shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities.

    The Act says 15 per cent of the fund shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities; and10 per cent of the fund shall be used for the development of Human Resources for Primary Health Care while  five percent of the fund shall be used for Emergency Medical Treatment to be administered by a Committee appointed by the National Council on Health.

    The National Primary Health Care Development Agency shall disburse the funds for items

through State and Federal Capital Territory Primary Health Care Boards for

distribution to Local Government and Area Council Health Authorities.

For any State or Local Government to qualify for a block grant, such State or Local Government shall contribute -(a) in the case of a State, not less than 25 per cent of the total cost of projects; and (b) in the case of a Local government, not less than 25 per cent of the total cost of projects as their commitment in the execution of such projects.

    The National Primary Health Care Development Agency shall not disburse money to any Local Government Health Authority if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of the Act or State or Local Government that fails to contribute its counterpart funding and; states and local governments that fail to implement the national health policy, norms, standards and guidelines prescribed by the National Council on Health.

    The National Primary Health Care Development Agency shall develop appropriate guidelines for the administration, disbursement and monitoring of the fund with the approval of the Minister in Council. Just like many other noble laws enacted but left unenforced, this one must not suffer the same fate!