The need to safeguard human rights has been an issue of global concern for long. At international level, the drive to ensure the protection of human rights has spawned the a plethora of human rights treaties and instruments, a prominent one being the Universal Declaration of Human Rights, adopted in 1948 by the General Assembly of the United Nations. True, the Universal Declaration of Human Rights is a resolution with no clear-cut force of law; however, because of its moral and political authority its basic provisions have been subsequently integrated in many international, regional and national legal instruments operating in Nigeria and beyond.
Among the rights which the international community has struggled to respect, fulfill and protect is the right of people to the enjoyment of effective healthcare. Along this line, echoing the 1946 Constitution of the World Health Organisation, Article 12 of the International Covenant on Economic, Social and Cultural Rights provides that “[t]he States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Similarly, Article 16 of the African Charter on Human and Peoples’ Rights (which Nigeria has domesticated as African Charter on Human and Peoples Rights Act) provides, “1. Every individual shall have the right to enjoy the best attainable state of physical and mental health.2. State Parties to the present Charter shall take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick.” The Nigerian government has never disputed its obligations to safeguard the health of its people. For example, the government unequivocally declared in the 2003 Nigerian HIV/AIDS Policy, that “Nigeria recognizes its responsibility to provide access to health care for all its citizens.”
As will be highlighted subsequently, Nigeria’s healthcare delivery system has for long been in gross shambles. This has made doubtful the realization of Nigerians’ “right to enjoy the best attainable state of physical and mental health” as envisioned under the pertinent human rights instruments earlier noted. Over the years, successive governments have made attempts to confront the problems plaguing Nigeria’s healthcare system. a current and highly prominent measure in this respect is the National Health Bill passed on May 19, 2011 by the Nigerian legislature. This Bill, somehow, has been an object of divisive and emotive debates among different stakeholders. The disputes, among other undesirable consequences, have stalled the transition of the Bill into an enforceable legislation binding on the Nigerian government as a central stakeholder. Generally, the cacophonic wrangling has beclouded the glimmer of hope of deliverance which the provisions of the Bill hold for Nigeria’s much troubled health system.
It is against this background that this paper, from the perspective of citizens’ right to wholesome healthcare services, seeks to engage the intense debates in which the National Health Bill has been immersed. The motivation for this input is a fundamental concern that the controversies and agitations over the Bill, if not pragmatically handled or resolved, can prejudice the help which the provisions of the Bill can offer in improving the state of healthcare delivery in Nigeria. There may thus be an elongation or perpetuation of the sordid state of healthcare in Nigeria - a situation that may further jeopardize the actualization of the right of every Nigerian to the enjoyment of the highest attainable standard of physical and mental health.”
It is trite that over the years, due to poor funding, corruption, ineffective management and other factors, Nigeria’s healthcare delivery system at all its levels has been in a morbid state of decadence. Government hospitals and other health providing institutions are not adequate and easily accessible. Where they exist, the institutions are, more or less, consulting and prescribing centres for helpless patients who daily throng the institutions. The health institutions, which in many cases are in dilapidated conditions, generally lack required drugs, basic equipments and facilities. Even, in some tertiary and secondary health centres, water and electricity supplies are not available, while the antiquated medical equipments are of little or no use due to breakdown or obsoleteness, constituting more of environmental eyesore and debris. The appalling state of healthcare providing institutions in Nigeria has also been the situation of health training institutions, with the universities and related establishments lacking appropriately equipped laboratories and other training facilities. By and large, the training institutions have been churning out and unleashing relatively poorly-trained and ill-equipped health care professionals on helpless members of the society who are compelled to seek their services.
Apart from problems of funding, facilities and others earlier noted, Nigeria’s healthcare system has also been severely affected by the problem of incessant industrial actions by health workers and other forms of work related conflicts in the health sector. Due to dissatisfaction with working conditions, frustrated health workers continually go on long strikes in demand for improved conditions of service or more conducive working environment. The strikes, whenever they occur, inevitably cause serious disruptions in the provision of health services to patients with the attendant dehumanizing sufferings and loss of lives.
Also, due to frustrations with the Nigerian health care system or a natural desire for improved professional or economic fortunes, many highly skilled health workers, especially doctors and nurses, simply abandon the country to take up jobs in more conducive work environments abroad. Based on the diverse ‘success stories’ of the health workers who eloped abroad, many of those constrained to remain in Nigeria tend to devote their energy and attention to the pursuit of dreams and schemes of travelling abroad. With such mindset, the commitment of many Nigerian health workers to their tasks becomes debatable with possibility of perfunctory and grudging performances. This trend labeled “brain drain” has left the Nigerian healthcare sector depleted and deprived of highly skilled health workers in various fields. In underscoring the depth of the brain drain problem, a source has found that “there are as many Nigerian doctors working in the USA [alone] as there are in the public health-care sector of Nigeria.”
Due to the problems with Nigeria’s public healthcare sector, citizens are willy-nilly constrained to embrace the private healthcare providers. This is also beset with a host of problems. Because of financial constraints, many people cannot attend the high-brow comparatively well-equipped healthcare providers. They are more apt to patronize the relatively affordable providers, which may be staffed with anything from people without the requisite professional training to outright quacks and fraudsters. In some cases, some people may not even be able patronize the “affordable” health centres. Such people tend to resort to self-treatment by patronizing patent medicine stores and itinerant drug hawkers carrying on trades on the streets, at motor parks, markets and other venues. In these scenarios, patients are more prone to the endemic problem of cheap fake drugs confronting Nigeria. Arguably, in order to reduce costs, “affordable” private health providers are more likely than the “expensive” providers to acquire and dispense cheap and, probably, fake or expired drugs. The same reasoning would apply to the itinerant drug hawkers. Apart from exposure to fake drugs, patrons of these treatment avenues are exposed to the risks of wrongful and harmful drug prescriptions or dosages that can create another line of health problems.