DEMOCRACY AND THE RIGHT TO HEALTH
In the words of Professor Michael Reich in 'Democracy and Health', democratization involves a process of political change that increases the democratization involves a process of political change that increases the degree of peaceful competitive political and civil liberties at the same time. After more than a decade of continuous democracy in Nigeria, citizens are not yet assured of the right to health which is a civil liberty. Indeed, one of the several causes of increased mortality and morbidity among the citizenry is lack of access to basic health care.
One of the reasons for this situation is that the National Health Bill which was introduced in the national assembly about five years ago in order to bridge the constitutional lacuna created by the absence of a valid provision for health in Nigeria's current constitution, is yet to be passed into law by the parliament and submitted to the President for accent.
In fact, a recent Nigerian Tribune newspaper report quoted the Chairman of the Health Committee of the Nigeria's Federal House of Representatives as having said that the Health Bill is yet to go through a third reading in the House. The Senate had only passed it in May 210. That this Bill is still hovering in the chambers of the National Assembly five years after its introduction, speaks volumes of the importance our democracy attaches to the citizens' wellbeing.
As it is now, nobody yet knows when it will become law and benefit the majority of Nigerians. Similar things can be said of other legislative instruments and actions required to provide better health for all Nigerians. The anti-stigma Bill designed to end stigma and discrimination against persons living with and or affected by HIV and AIDS has been lying within the legislative houses for years now.. un-passed! The right to basic health care as envisaged in the draft bill, is still denied the citizens.
The World Health Organisation (WHO), in its 2008 World Health Report emphasized that the fundamental step a country can take to promote health equity is to move towards universal coverage and provide universal access to the full range of personal and non-personal health services they need, with social health protection. Even the National Health Insurance Scheme has been established to enhance the pooling of pre-paid contributions collected on the basis of ability to pay, and using these funds to ensure that services are available, accessible and produce quality care for those who need them, without exposing them to the risk of catastrophic expenditures. Even this has its limits as to what health care services are accessible to various shades and levels of subscribers within the scheme. It still does not promise or offer access to health care needs for all citizens.
Looking at the Nigerian situation, one may be compelled to agree with Franco A et al in 'Effect of democracy on health: ecological study' when they posited that the level of inequality within a country may be an important determinant of health, and therefore that the potential confounding effect of wealth and its distribution within a country should be taken into account in assessing the impact of democracy on health. The differential access to health care in Nigeria, even in public health institutions like the National Hospital and various teaching and specialist hospitals is a ready example. Majority of the citizenry cannot afford the cost of services in these hospitals, and die as a result of lack of care.
Writing in African Security Review journal, David Zounmenou opined that in almost all constitutions across the world, one of the most important requirements for any candidate in a presidential election is a clean bill of health delivered by a competent and honest medical institution. Zeroing in on Nigeria, the most recent event is the prolonged illness of our former President, his trip to Saudi Arabia for treatment and most embarrassingly, the inability of the Nigerian health system to sustain his health upon return, despite that fact that his health condition was already known, and Nigeria has the resources to provide the best care possible.
One does not need to dwell on all the tissues of lies, contradictions and confusions that characterized his sickness and unfortunate death. While it lasted, neither the government officials, nor health care managers could tell Nigerians the truth about the President's health condition. Nigerians had to rely on the cable news network for updates on the health of their leader. The wonder is: what will be the fate of the next Nigerian of any status who come down with the same illness as the former President? Even with the experience of the former President's illness, can our health system handle a similar case now? Will the next person who comes down with the same illness die?
As reported by Franco A, Alvarez-Dardet C and Ruiz MT in Effect of democracy on health: ecological study', welfare state policies have been associated with health benefits in people from countries belonging to the Organisation for Economic Cooperation and Development. There are countries in our region and in the developing world with fewer resources than Nigeria, but have managed to build health systems that guarantee universal and equitable access, that ate collective and participatory, and at the same time ensure efficiency, effectiveness, and quality. As we celebrate our 50th independence anniversary and World Democracy Day, Nigeria, with its huge population - projected to be 326 million people and fifth largest in the world by 2050, cannot afford to continue to pay lip service to the provision of universal health care for all its citizens/inhabitants.
The following demands have become pertinent: that the National Health Bill for an act to provide a framework for the regulation, development and management of a national health system and set standards for rendering health services in the Federation, and other matters connected therewith, be passed and signed into law forthwith; and states should subsequently domesticate this law for timely implementation of its provisions.
That Nigeria should lead other African countries by allocating at least 15% of her annual budget to health at Federal, State and Local Government levels; and set immediate, medium and long term targets for her health and development indices, with an effective monitoring and evaluation mechanism in place. As the January 2011 elections approach, stakeholders in Nigeria's health and development sector should rally to put health strongly on the political agenda, and receive firm commitments for health, from the candidates and political parties; and the Honourable Minister of Health should lead in giving fresh impetus to Health Sector Reforms and freely accessible universal primary health care in the country.
Ultimately, it is only a health population that can ensure the economic development in a stable democratic environment that we all hope for, and seek?
. Adirieje writes from Lagos.