NHFRA Bill will spark fresh health crisis, ACPN tells Senate

The Association of Community Pharmacists of Nigeria has urged the Senate to stop the proposed National Health Facility Regulatory Agency Bill, arguing that it would duplicate existing health regulatory structures and “jeopardise” the “fragile peace” within Nigeria’s health sector.

The association made this prayer in a letter addressed to the President of the Senate, Godswill Akpabio, and signed by its National Chairman, Ambrose Ezeh.

The letter, titled “Stop the National Health Facility Regulatory Agency (NHFRA) Bill in National Interest,” and shared with PUNCH Healthwise, asserted that the National Health Act of 2014 already provides for the regulation of health facilities and professionals in Nigeria, making the proposed agency unnecessary.

Ezeh maintained that instead of the proposed legislation seeking to create a new agency, gaps in the existing structure should be addressed through the implementation of the Act.

The association traced the regulatory history of healthcare practice in Nigeria, noting that pharmacy and drug matters fall under the Exclusive Legislative List, which empowers only the National Assembly to make laws on the subject, while other health professions are regulated under separate councils.

The letter read, “The status quo before 2014, when we had a National Health Act, was that all the major professions had Professional Regulatory Agencies/Councils, which regulated and controlled their professions. Drug matters are listed on the Exclusive List as item 21 in Part 1 of the 2nd Schedule in the 1999 Constitution.”

The community pharmacists argued that bodies such as the Pharmacy Council of Nigeria, the Medical and Dental Council of Nigeria, the Nursing and Midwifery Council of Nigeria, and the Medical Laboratory Science Council of Nigeria already regulate their respective professions, while state governments regulate hospitals and other health facilities within their jurisdictions.

The ACPN insisted that the proposed NHFRA Bill mirrors an earlier attempt during the drafting of the National Health Act to place all health professions under the control of the medical profession, a clause it said was resisted by the Pharmaceutical Society of Nigeria and the Joint Health Sector Union before the Act was eventually passed in 2014.

It said, “For over ten years, it was impossible to have a National Health Act because the first proviso in the draft bill in section 1(I) had posited that there shall be a ‘National Health System which shall Regulate and Control all the health professions.’ The Pharmaceutical Society of Nigeria (PSN) and Joint Health Sector Union (JOHESU) stoutly resisted this clause, which was a clever ploy to undermine all the health professions by placing them under the stewardship and control of their counterparts in medicine. This has been crafted in the proposed NHFRA bill in Section 11(6), where the office of the Director-General has been ceded to ONLY Physicians.”

The association recalled that the resistance to the clause was eventually resolved through advocacy visits by the leadership of the PSN and JOHESU to the then Senate President, David Mark, and the then Speaker of the House of Representatives, Aminu Tambuwal, in February 2013.

This led to an amendment that now states that the National Health System shall regulate all health professions “without prejudice to extant professional regulatory laws.”

It said, “This is the current state of the law as enshrined in what is probably Nigeria’s most supreme health statute. The ACPN is left to wonder what then drives this agenda of a new NHFRA which will come with Legal and Structural imperatives when all the professions and health facilities already have agencies that should regulate them.”

The association noted that the only category of health facilities currently without a dedicated regulator in Nigeria is tertiary health institutions at the federal level, including teaching hospitals and federal medical centres, and blamed this gap on what it described as the Federal Ministry of Health’s failure to implement an existing provision of the National Health Act.

The community pharmacists prayed the National Assembly should instead activate provisions of the National Health Act establishing a Tertiary Health Facility Commission to regulate federal tertiary hospitals, describing it as the “major area of deficiency” in the country’s health regulatory landscape.

Ezeh further called on the Federal Government to strengthen existing regulatory bodies, including the Pharmacy Council of Nigeria and the National Agency for Food and Drug Administration and Control, rather than create a new agency.

It said, “It is our conviction that we must encourage the Federal Government to improve funding of the PCN, NAFDAC and other Professional Regulatory Councils to elevate their statutory outputs and ultimately health outcomes in the public interest. The enabling Acts of Parliament that establish the PCN, NAFDAC other Professional Regulatory Councils are specific laws which cannot be superseded by general laws of any type or nature.”

In its prayer to the National Assembly, the ACPN urged lawmakers to instead activate provisions in the National Health Act 2014 to establish a regulatory commission for federal tertiary hospitals, which it described as the actual gap in Nigeria’s health regulatory framework.

It said, “The National Assembly is invited to activate the necessary templates in the NH-Act 2014 to establish the Regulatory Commission that will regulate Tertiary Hospitals at the Federal level, which is the major area of deficiency in the Health regulatory landscape in our sector.”

The association further alleged that the committee that drafted the proposed NHFRA Bill was overwhelmingly composed of physicians, which it said raised concerns about the agenda behind the bill.

It said, “Nothing buttresses the viewpoint that this is an agenda of suppression more than the fact that membership of the originating Committee to superintend the proposed NHFRA was made up of physicians to the extent of 99 per cent, which in itself spells doom for the Health Sector because inputs accrued from only one profession in a multidisciplinary sector.”

The ACPN warned that pursuing the bill could disrupt what it called a “fragile peace” in the health sector, and urged the National Assembly to avoid duplicating functions already assigned to existing structures under the National Health Act.

It said, “The National Assembly and Federal Government should leverage on the existing status-quo that has ensured some relative peace in the Health Sector by jettisoning any move that will stir the hornet’s nest, as any agenda bordering on a centralised Health Regulatory Facility Agency will be grounded in immediate suspicion which will jeopardise our fragile peace and this will definitely be resisted by stakeholders.”