By Eze Onyekpere
The right to health is an empowering right that greatly facilitates the realisation and enjoyment of other human rights and fundamental freedoms. It is a part of the most fundamental of the fundamental human rights which is the right to life, as it supports the fulcrum upon which other rights rotate. To underscore the indivisibility and inter-relatedness of the rights to life and health is the fact that one of the easiest ways to deprive someone of his life is to deny him of health-supporting conditions to the point of abrogation. Nigeria is bound by national and international standards on the right to health and these include the standard setting Universal Declaration on Human Rights, the International Covenant on Economic, Social and Cultural Rights, Convention on the Elimination of All forms of Discrimination against Women, Goal 3 of the Sustainable Development Goals (SDGs) and the regional African Charter on Human and Peoples Rights. Others include the Alma-Ata Declaration on Primary Health Care clarified in the Declaration of Asanta. The states and local governments, being parts of the Federal Republic of Nigeria are bound by these standards.
At the national level, there is the constitutional obligation under the Fundamental Objectives and Directive Principles of State Policy on adequate medical and health facilities for all persons; National Health Act of 2014, National Primary Health Care Development Agency Act, National Health Insurance Authority Act, National Health Policy of 2016 and the National Strategic Health Development Plan 2018-2022. Health is not mentioned on Nigeria’s Constitutional Schedules as the federal, state and local governments all have a role to play. This is not to deny the overall policy and leading role of the Federal Government of Nigeria through the Federal Ministry of Health and relevant agencies and institutions in taking the lead in efforts to realise the right to health of all Nigerians.
These national and international standards all point in the direction of Universal Health Coverage (UHC). UHC connotes a scenario where all persons have access to the health services they require, at the necessary time and where they are needed without financial hardship. The services being referred to include essential health services ranging from health promotion to prevention, treatment, rehabilitation and palliative care. As part of SDG 3, UHC includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. An appropriate articulation of UHC must essentially include the cardinal parametres of the right to health vis, availability, accessibility (non-discrimination, physical, economic and information accessibility), acceptability, quality as well as cultural acceptability. UHC requires competent human resources for health operating under an enabling and adequately resourced environment that understands the inseparability, indivisibility and interrelatedness of the right to health and other human rights and fundamental freedoms.
Experts have posited that health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions: Non-discrimination: health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds. Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS. Accessibility also implies that medical services and underlying determinants of health, such as safe and potable water and adequate sanitation facilities, are within safe physical reach, including in rural areas. Accessibility further includes adequate access to buildings for persons with disabilities. Economic accessibility (affordability): health facilities, goods and services must be affordable for all.
Payment for health-care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households. Information accessibility: accessibility includes the right to seek, receive and impart information and ideas concerning health issues. UHC envisions a whole-of-government, health-in-all policies and whole-of-society approach towards the realisation of the right to the highest attainable state of physical and mental health. The whole of government approach is an understanding that securing the health of the population cannot be achieved by the Ministry of Health and its departments and agencies alone. It requires inter-ministerial/agency collaboration and mainstreaming health in other sectors. Health is made an explicit objective of every policy decision.
Health in all policies approach is a collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people. The first two approaches (whole-of-government, health-in-all policies) are interrelated and involve governance and policy making. On the other hand, the whole-of-society approach involves the engagement of all relevant stakeholders in society to address socio-economic and livelihood issues including public health, education, food security, agriculture, power and energy, communications, environment, employment, industry, and social and economic development. It seeks to move away from the medicalisation of health to a more well-nuanced understanding of the various factors affecting the health of the population and the stakeholders who can contribute to more positive health outcomes.
The government and people of Nigeria need a clearer understanding of the right to health, its key determinants and factors that promote and facilitate a healthy population. This will improve policy formulation and implementation while increasing demand for improvements.
Onyekpere writes from Lagos