Nigeria Beyond Ebola

ABUJA – When the World Health Organization declared that Nigeria had successfully eradicated the Ebola virus within its borders, there was loud global applause. Amid the cheers, however, few noticed a potentially even greater health milestone for Africa’s most populous country: the enactment of a new National Health Bill, which now awaits President Goodluck Jonathan’s signature.

If the bill is signed into law, it could transform Nigeria’s health-care system, providing a model for other West African countries seeking to learn the lessons of the Ebola epidemic and provide health care to all of their citizens. Jonathan is running for re-election in February. Signing the bill would demonstrate his commitment to improving health services for Nigerians, and blaze a trail for others to follow.

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Ebola appeared in Nigeria when an infected traveler from Liberia arrived in Lagos in July. The consequences of a major outbreak among the 22 million inhabitants of Africa’s largest city could have been catastrophic.

Instead, the authorities acted swiftly, isolating patients and monitoring their contacts for 21 days. They screened travelers entering the country and conducted a major public-information campaign to educate citizens on how to contain the epidemic. In August, the virus spread to Port Harcourt in the east of the country, but it was quickly controlled there, too. Jonathan’s strong leadership, along with strong support from the leaders of the two key Nigerian states directly affected by Ebola, was instrumental in preventing the disease from spreading.

Nigeria’s rapid response to Ebola made use of the infrastructure of a polio-eradication program that has almost rid the country of the disease. But, though these types of targeted campaigns have had success in West Africa, most national health-care systems in the region are under-resourced and lack skilled personnel. They are also often heavily tilted toward urban populations and exclude the poorest. The ferocity and persistence of Ebola in Liberia, Sierra Leone, and Guinea underscores these systems’ fragility.

The National Health Bill awaiting Jonathan’s approval shows what a stronger health-care system might look like. It would recognize the right of all Nigerians to a minimum standard of services, and would establish a national system with support structures from the federal government all the way down to villages and local wards. The infrastructure would be organized around the existing National Council on Health, and would be financed by an annual grant of 1% from the federal government’s Consolidated Revenue Fund and contributions from state and local government entities.

Some 50% of the funds would be spent on an expanded, revitalized National Health Insurance Scheme. Another 20% would be allocated for essential drugs, medication, and supplies; 15% would be spent on facilities, research laboratories, and transportation; 10% would go toward staffing; and 5% would be earmarked for emergency services.

The bill would guarantee a basic health package for all Nigerians, and requires universal acceptance of accident and other emergency cases by all health facilities, both public and private. Pregnant women, the elderly, people with disabilities, and all children below the age of five would receive free health care.

The legislation would establish national standards for services, care, and treatment, and mandate coordination with the private health system, including traditional and alternative health-care providers. It also empowers the health minister to resolve, within a fortnight, industrial action – a persistent challenge confronting Nigeria’s health sector – and would curb the use of public funds by Nigerian public officials and civil servants seeking treatment abroad.

Finally, the bill provides for research on the state of the country’s health. Collecting and analyzing relevant data is vital as the country struggles to achieve the Millennium Development Goals established in 2000, particularly the targets for improving maternal health and reducing infant and child mortality.

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These are ambitious goals, and Nigeria is starting from the low baseline of a poor health-care system. But the country has shown that it has the ability to achieve impressive results when effective leadership rallies its administrative and medical institutions. Nigeria took on a potentially devastating opponent – the Ebola virus – and won.

But time is short. The deadline to sign the bill is fast approaching. Jonathan has an enormous opportunity to show that Nigeria will go beyond its battle against Ebola and transform health care for the entire country. This would establish an extraordinary legacy for his current term in office; indeed, signing the bill would demonstrate leadership that few of his predecessors have shown.