Dear all HIFA members:
This week, as we turn our attention to the questions "From your experience, what might work best to enhance national commitment to quality of care? Have you seen any practical solutions that should be shared wider?", I wish to make my initial submission - the case of Nigeria - as follows.
Nigeria is a signatory to several global initiatives and agenda on health and development, including the Sustainable Development Goals (SDGs).
Nigeria's Federal Ministry of Health (FMoH) has departments, agencies, policies and other structures to ensure the provision and delivery of health services to the country's population. In 2014, the health system received a boost with the enactment of the National Health Act.
However, there is no 'National Quality Policy and Strategy (NQPS)' to promote and plan for improved quality of care outlined in a document, providing an official, explicit statement of the approach and actions required to enhance the quality of health care across (the) health system, 'linked closely with the wider national health policy and planning', as recommended by the WHO (https://www.who.int/news-room/q-a-detail/q-a-who-handbook-for-national-q... ).
The Nigeria National Quality Policy (NNQP) which was approved early this year (2021) does not related specifically to health or quality of care.
Nevertheless, there are some national instruments that have provisions for quality of care. The first is the National Health Act 2014 ( http://www.ilo.org/dyn/natlex/docs/ELECTRONIC/104157/126947/F-693610255/... ).
The second is the National Quality Assurance Policy for MEDICINES & OTHER HEALTH PRODUCTS (NQAP) ( https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&u... ).
The Act does not explicitly provide for quality of care or formulation of any policy thereof, but has several provisions that allow for the provision of quality health services.
Primarily, the National Health System defines and provides a framework for standards and regulation of health services, without prejudice to extant professional regulatory laws (section 1, subsection (1) of the National Health Act 2014).
Section 13, subsection (1) (c) states that 'Without being in possession of a Certificate of Standards, a person, entity, government or organization shall not provide prescribed health services'.
Section 19, subsections (1) and (2) state further that 'All health establishments shall comply with the quality requirements and standards prescribed by the National Council on Health. The quality requirements and standards may relate to human resources, health technology, equipment, hygiene, premises, the delivery of health services, business practices, safety and the manner in which users are accommodated and treated.' Thus, the Act recognizes the fact that several factors and actors need to considered to ensure the delivery of quality health services.
The Act also mandates every health care provider to enable every user have full knowledge/ information pertaining to her/his state of health and necessary treatment relating to- (a) the user's health status except in circumstances where there is substantial evidence that the disclosure of the user's 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 the implications, risks or obligations of such refusal.
Some have argued that the absence of a National Quality Policy on quality of care may be responsible for the poor health outcomes in the country. But the fundamental requirements are already in place.
Thus, in my view, a legal framework (for the regulation, development and management of a national health system that set standards for rendering health services), a national health policy and a national quality policy and strategy (NQPS) to promote and plan for improved quality of care are KEY approaches that can enhance national commitment to quality of care.
ORFEGA, *Moses Kumaoron*
HIFA profile: Moses Kumaoron Orfega is a Service Improvement Desk Officer at the National Health Insurance Scheme, Nigeria. Professional interests: Social Protection and Financing; Social Health Protection and Universal Health Coverage; Service Quality Improvement; Information Technology. He is a HIFA catalyst for the WHO/HIFA project on Learning for Quality Health Services. Email: ofegamoses AT gmail.com