The earliest account for the call for a national action towards quality healthcare in Nigeria that we have located was in 1952 before Nigeria gained independence from Great Britain in 1960. The quality struggle has been chequered.
In 1952, the British Medical Association established a branch on Lagos Nigeria which became the Nigerian Medical Association in 1960 at independence. Its pioneer President Dr Majekodunmi became the first Minister of Health, and continued to champion the Quality Agenda that the Association had already committed itself to fight for. Fast forward to 1966-1970 the civil war interrupted any progress and during the subsequent years after 1970, several efforts were made by the various ministers of health under a prolonged period of Military Rule till 1999 when it handed over to democratically elected government that has governed till today. During the military rule sevekay health policies were released but none became Law. The most significant effort towards systematized quality Agenda was that put forward by the Late Professor Olikoye Ransome-Kuti, immediately when WHO released the Alma Ata declaration. He underlined the fact that the primary health tier held the key to unraveling poor health care outcomes in the country, leading to the establishment of the National Primary Health Care Development Agency. He served the country twice as Minister of Health but whenever he left that office the road map was reversed in real terms. Nigeria continued to travel on this chequered route until eventually on 2014, the National Health Act (NHA 2014) became Law, attempting to bring together all the good points and objectives of previous policies.
To answer Neil's question, we can say that today, the status of quality health care in Nigeria should be looked at from the status of the implementation of the provisions of the NHA 2014. The Act provides that within 24 months of its becoming effective (which was 31st October 2016) every health facility in the country should have a certificate of standard and it should display it in the premises for public information. After long delays and outcry from the professions especially the NMA, the minister of Health in March 2017 inaugurated a key committee provided for in the NHA, the National Tertiary Health Institutions Standards Committee (NTHISC). Observers have queried why only the tertiary health institutions should have standards.
The committee has not been fully active even though in 2019, the Federal Ministry of Health launched a '˜Quality Checklist' which was authored by a consultant! Not much has been heard about the document since, and not much has been heard from the NTHISC since, too.
The lacuna has meant that independent organizations like the HRI West Africa (www.hriwestafrica.org) founder of the 12-Pillar Clinical Governance Programme and others have been very busy trying to advocate and promote such home-grown quality care tools to cover all three tiers of the health system. In addition, a few private hospitals that are committed to quality care, like the Lily Hospital, Warri and others have gone outside Nigeria to countries like South Aftica, to gain quality health facility accreditation.
So, Nigeria since 2014 has had a Health Law that mandates the country to ensure that all health facilities provide quality care which is benchmarkable to best standards comparable to what exists in the countries that millions of Nigerians troop to every year on medical tourism, spending according to several reports over $1 Billion per year. But achieving that goal is still a long way away, despite the best efforts of the independent actors.
Very Interestingly, the NMA seems to have come full cycle from 1952, because in 2012, it created the NMA Standing Committee on Clinical Governance, making its advocacy for quality health care in Nigeria, permanent, year on year.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk