Health Priorities and Strategic National Public Health Programs
In spite of all the efforts made by the government, Nigeria still have to struggle against issues regarding its health system (the country’s result are still very high for the region). Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000[5]). In recent years, migration to foreign countries has declined and the primary challenge for Nigeria is inadequate production and inequitable distribution of health workers. The health workforce is concentrated in urban tertiary health care services delivery in the southern part of the country, particularly in Lagos (HRH Country Profile: Nigeria, WHO GHWA, 2008[6]). This inequity has been attributed to:
In 2009, the government also developed a plan applauded by the WHO: it aimed to create a community service in rural zones for retired doctors, people unemployed in the medical sector and young medicine graduates.
[1] http://www.loc.gov/law/foreign-news/article/nigeria-national-health-bill-enacted/
[2] Lawyers Alert
[3] Lawyers Alert
[4] Nigeria Federal ministry of health
[5] World Health organization: country profile Nigeria
[6] World Health organization
- In 2014, president Goodluck Jonathan signed into law the National Health Bill. After ten years of conceptions, discussions and negotiation, the law has finally been voted and aims to improve the country’s healthcare system. This include access to primary care for vulnerable segments of the population, such as women, children and the elderly. The legislation includes notable language making the provision of emergency health services mandatory and failure to do so a crime. Refusal to provide emergency health service is an offense punishable on conviction by up to six months in prison and/or a fine of NGN100,000 (about US$555)[1].
- The Act is set to achieve the Universal Health Coverage and meet the Millennium Development Goal (MDGs) target. The Act also provides for the elimination of quacks from professionalism and provide basic health funds needed by Nigerians. The Act was also enacted for the purpose of providing healthcare insurance to certain class of people who are actually deprived. The Act seeks to help Nigeria reduce maternal and infant mortality rate by 2015. More pregnant women would have access to free delivery services while their children are assured of standard pediatric services in the nation’s health facilities.
- The basic health care provision fund shall be financed from Federal Government Annual Grant of not less than 1% of its Consolidated Revenue Fund and grants by international donor partners. The funds shall be managed by three national entities such as
- The National Health Care Development Agency which will manage 45%[2] of the fund to be disbursed through each state and the FCT Primary Health Care Development Board for the provision of essential drugs, vaccines and consummates
- The National Health Insurance Scheme which will manage 50%[3] of the fund for the of basic minimum package of health facilities
- The Federal Ministry of Health will manage 5%[4] of the fund for the provision of basic minimum package of health facilities. The Act is also for the purpose of providing health care insurance for certain class of people who are actually deprived. The Act also provides that the NHIS would provide health coverage which will cover pregnant women, children who are under five years, the elderly and the physically challenged persons. The Act also provides that part of the funds would be used to train nurses and midwives.
In spite of all the efforts made by the government, Nigeria still have to struggle against issues regarding its health system (the country’s result are still very high for the region). Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000[5]). In recent years, migration to foreign countries has declined and the primary challenge for Nigeria is inadequate production and inequitable distribution of health workers. The health workforce is concentrated in urban tertiary health care services delivery in the southern part of the country, particularly in Lagos (HRH Country Profile: Nigeria, WHO GHWA, 2008[6]). This inequity has been attributed to:
- lack of public and private sector coordination;
- favoring indigenous hires;
- commercial pressures in the private sector that lead to poor quality work;
- work environments that contribute to low motivation, less-than-optimal productivity, high attrition - especially from rural areas; and
- lack of planning based on staffing projection needs resulting in an overproduction of some categories of health workers and a lack of others (Federal Republic of Nigeria HRH Strategic Plan 2008-2012).
- use of telemedicine;
- financing/aid arrangements with other countries where significant populations of Nigerian health workers live plus efforts to enable easier transition to Nigeria; and
- actively managing brain drain.
In 2009, the government also developed a plan applauded by the WHO: it aimed to create a community service in rural zones for retired doctors, people unemployed in the medical sector and young medicine graduates.
[1] http://www.loc.gov/law/foreign-news/article/nigeria-national-health-bill-enacted/
[2] Lawyers Alert
[3] Lawyers Alert
[4] Nigeria Federal ministry of health
[5] World Health organization: country profile Nigeria
[6] World Health organization
Specific policy/norms/regulations for HRA and HIA (or ESHIA)
Specific policies/processes for improving workers' protection
[1] The economist : Nigeria, we happy few
[2] http://www.crossborderemployer.com/post/2015/06/23/Employment-Law-in-Nigeria-Part-I.aspx
[3] http://www.oseroghoassociates.com/articles/88-employment-laws-in-nigeria-in-the-21st-century
[4] THE STATE OF WORKERS' RIGHTS IN NIGERIA: An Examination of the Banking, Oil and Gas and Telecommunication Sectors : Prof. Funmi Adewumi Dr. Adebimpe Adenugba
- Human resources accounting has always been a problem in Nigeria. In colonial times the numbers were probably roughly right, but the first post-independence census in 1962 was already shamelessly rigged. The issue mainly steams from the fact that resources accounting are made by locals. An initial count suggested massive growth in eastern and western districts, which claimed that their population had increased by an average of 70% over the previous decade, compared with a 30% increase in the north. That would have shifted power from the northern elites who controlled the country, so they quickly scrapped the count and started again. Political interests also interfere in the miscounting in the country. Indeed, this time, miraculously, the north’s population was found to have increased by 84% (an extra 9m people), just enough to ensure it had slightly more than half Nigeria’s population Almost every census since then has been disputed. One in 1991 was ditched when it seemed to show that the country’s total population was about 30% smaller than expected.
- The latest one, conducted in 2006, put the total at 140m, a number that provides the basis for current estimates and forecasts. But some academics reckon that the population of some northern states was inflated by about a quarter, whereas that of some southern areas was trimmed in response to political pressure on the statisticians. The number of people in Lagos, the main southern commercial centre, was said to be just over 9m. That allowed northern rulers to claim that Kano, the main northern commercial centre, had more people and was thus entitled to more resources. Lagos officials subsequently did their own count and claimed 17m.[1]
- Even allowing for all these swings and roundabouts, some researchers, using sophisticated satellite imagery and geographical information systems, reckon that the 2006 census considerably overstated Nigeria’s urban population, mainly in the north but also in some southern cities. That means Nigeria’s current population may be closer to 160m than 180m.
Specific policies/processes for improving workers' protection
- Employment law in Nigeria is generally employer friendly. Nevertheless, there are federal and local employment and labor laws that govern contracts, wage and hour, discrimination, terminations, lay-offs and privacy. Any company conducting business in Nigeria or considering doing so should be familiar with the various laws which govern the employment relationship.
- With regard to private employers, Nigerian Labor and Employment law is largely based on the following statutes: the Labour Act of 2004, the Trade Union Amended Act, 2005, the Employees Compensation Act, 2010, the Factories Act, 2004, the Pensions Act, 2004; and the Trade Disputes Act, 2004.
- The Ministry of Labour and Productivity (the Ministry) is the main regulatory agency. Enforcement of employment statutes and regulations falls under the auspices of the National Industrial Court with regard to discrimination claims, there are no laws that specifically prohibit discrimination or harassment in the employment context. However, Section 42 of the Nigerian Constitution provides for freedom from discrimination on the basis of sex, age, ethnic group, and political affiliation.[2]
- The Labour Act ("The Labour Law") with a commencement date of 1st August 1971 remains the applicable Law in Nigeria in this area - though some commentators have argued that its provisions are only applicable to unskilled and manual workers. While unfortunately, relevant amendments have not being made to this Law to bring it up to speed on modern developments and practices, it remains the applicable Law in Nigeria. It is also a very worthy guide to you in managing your relationship with your employees or employer. The Labour Law provides that every employer must give to each of its employees a written contract within three months of the employer engaging the services of the employee. The contract of employment must sufficiently state the particulars of the employer and the employee, the position and job description/functions, other terms and conditions of the contract including hours of work, remuneration, holiday and holiday pay, incapacity due to illness or injury, etc. With the commencement of the implementation of the Pension Reforms Act and the National Health Insurance Scheme, etc it is recommended that the written contracts of employment should enumerate these benefits and liabilities between the employer and the employee in the employment contract. Most Corporations, in addition to the contract of employment, also ensure that they have a very detailed Staff Handbook which gives fuller details on other matters necessary for high efficiency and harmony in the employer/employee relationship. Examples of what the Staff Handbook should contain include wages and salaries and mechanism for adjustments, hours of work, overtime, annual holidays and vacation pay, disciplinary procedures, "whistle blowing"[3] procedures, redundancy principles, pensions, national health insurance scheme, union activities if any, etc.
- Although the Constitution allows for free association, including the formation of, or membership in labor unions, there is no specific legislation mandating works councils or workers’ committees. If employers are not forthcoming in respecting workers' rights, it becomes pertinent to ask what workers and their organisations are doing to address the situation. It appears that the unions have not been able to do much for their members in the face of right abuses from employers. The precarious situation in the labor market, compounded by the downturn in the economy, is not helping matters, as it makes workers very vulnerable.[4]
[1] The economist : Nigeria, we happy few
[2] http://www.crossborderemployer.com/post/2015/06/23/Employment-Law-in-Nigeria-Part-I.aspx
[3] http://www.oseroghoassociates.com/articles/88-employment-laws-in-nigeria-in-the-21st-century
[4] THE STATE OF WORKERS' RIGHTS IN NIGERIA: An Examination of the Banking, Oil and Gas and Telecommunication Sectors : Prof. Funmi Adewumi Dr. Adebimpe Adenugba
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