The Nigerian National Health Bill 2011: Delay of Presidential Assent to an Act: Issues Arising

7/30/2019 The Nigerian National Health Bill 2011: Delay of Presidential Assent to an Act: Issues Arising

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ABSTRACTth

The Nigerian National Health Bill (NHB) was finally passed by the N ational Assembly on May 19 2011 after many

years of delay. If the NHB is signed into law by the President of N igeria, Dr . Goodluck Jonathan, it becomes an act

that provides a framework for the regulation, development and management of the national health system and setstandards for rendering health services in the federation, and other matters connected therewith. The NHB is

arranged in parts and clauses, and there are seven main parts. Contained in the N H B are some good innovations, such

as the establishment of the National Primary Health Care Development Fund and National Tertiary Hospitals

Commission. Curr ently, the NHB is stuck in the presidency where it has been sent for Mr President 's assent, as health

sector professionals disagree over some parts and clauses in the Bill. The areas of conflict include: the headship of the

National Tertiary Hospitals Commission, the establishment of the Nigerian National Health Council and

membership of the N ational Health System. Several appeals had been made to the President by organisations, groups

and individuals to sign the NH B into Law. The President had set up a Presidential Team to look into concerns raised

about the passed NHB and resolve the issues. Hopefully, the NHB will be signed by the President into law when these

issues are resolved.

The N igerian N ational H ealth Bill 2011: Delay of PresidentialAssent to an Act: Issues Arising

Dr. R.A. Adebayo MPA, FWACP,

Cardiology Unit, D epart ment of Medicine,

Obafemi Awolowo University,Ile-Ife, Osun Stat e,

Nigeria.

E-mail Addr ess: [email protected]

INTRODUCTION of a national health system and set standards

In 2004, the Federal Ministry of H ealth in for rendering health services in the federation,3,6,8

collaboration with the National Assembly and other matters connected therewith.

proposed a National Health Bill with thePrior to the National Health Bill, there had

purpose of providing a framework for thebeen no legal framework guiding healthcare

development and management of a structureddelivery in Nigeria. The health system was

health system in the country, taking intoguided by the National Health Policy which is

account the obligations imposed by thean expression of goals for improving the

constitution and other laws with regards to country's health situation and the mainhealth services.

direction for attaining the goals and this had

been in place since 1988. As Nigeria celebratedIt took about 10 years to achieve the passage ofth1-8 its Children's Day on May 30 2011, UN ICEFthe National Health Bill (NH B) on

commended the National Assembly forThursday, May 19, 2011 by the Senate of theth passing the NHB into law. The NMA also last (6 ) Nigerian N ational Assembly. All

commended the National Assembly on thethrough the long wait, various stakeholdersNH B passage. Addressing a press conferencecalled for the passage of the Bill. Presently, allon the 2011 H armonised Health Bill in Abuja,that remains outstanding is presidential assent

1 on Thursday, the NMA President, Dr Omedeto make the NH B a federal law. If signed, it

Idris said: the passage of the N ational H ealthbecomes an act that provides a framework for Bill is a demonstration of good political will ofthe regulation, development and management

JOURN AL OF CO MMUN ITY MEDICIN E AND PRIMARY H EALTH CARE VOL. 23, NO S 1&2, MAR/ SEPT. 2011 1


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JOURN AL OF COMMUN ITY MEDICIN E AND PRIMARY H EALTH CARE VOL. 23, NO S 1&2 , MAR/ SEPT. 2011 2

9 The NHB provides a framework for thethe N ational Assembly on health.regulation and provision of national health

services, defines the rights of health workers

and users, and stipulates guidelines for the

formulation of a national health policy. Its10 He declared that the N HB promises will not change everything for

was one good thing Nigeria can do for the N igerians, but the bill does allow them tovoiceless and downtrodden that still can't finally hold the government accountable foraccess health care and it would checkmate the their right to health, including equitable accessexcesses of people in government who seek for to care. Never before has there been suchforeign medical attention for what can be

momen tum towards mak ing a rea l11treated in Nigeria.

commitment to improving health in this1UNICEF also looked forward to its quick country .

assent by President Goodluck Jonathan to

make it immediately implementable across the SUMMARY OF THE CONTENTS OF5

nation. "The health status of children and TH E BILLwomen in Nigeria remain poor but we believe

The NHB is arranged in parts and clauses, and3that with careful implementation of the there are seven main parts .Part I is on

National Health Act, along with sufficient Responsibility for Health and Eligibility forfunding for and close monitoring of the Health services and Establishment of NationalNational Health Strategic Development Plan, Health System. Part II dwells on HealthNigeria will take firm steps to reverse this Establishments and Technologies. Part IIItrend," said Dr. Suomi Sakai, UNICEF deals with Rights and Duties of Users and

5Health Care Personnel. Part IV is on N ationalRepresentative in N igeria.

Health Research and Information System. Part"We expect the National Health Act to

V dwells on H uman Resources for H ealth. Parttranslate into the release of much needed VI is on Control of Use of Blood, Bloodfunding from national revenues for the health

Products, Tissue and Gametes in H umans. Partof children and women. Its focus on an VII deals with Regulations and Miscellaneous

3essential minimum package of care to tackle Provisions.the health problems which cause the highest

Part 1 of the N HB has been of special interestnumber of death and illness in children and

to many within and outside the Health Sector.women is highly commendable."Scaling up the 3

Its sections are as follows :implementation of an essential package of

Part I - Responsibility For H ealth Andproven, cost-effective and high-impactEligibility For H ealth Services Andinterventions in all primary health centres will

Establishment O f National H ealth Systembring Nigeria closer to attaining the health1. Establishment of the National Healthrelated MDGs."In doing so, we encourage the

SystemGovernment and its partners to leave no child

2. Functions of the Federal Ministry ofbehind, as this momentum is really about

Healthsecuring quality primary health care with

3. Eligibil ity for exemption fromequity - for every woman and every child. "We

payment for health services in publiclook forward to keep working with thehealth establishmentsGovernment and its partners to make Nigeria's

4. Establishment and Composition of thenew Health Act work for all children in theNational Council on H ealthcountry, irrespective of origin, creed,

5. Functions of the National Councileconomic status, disability and gender, said Dr.

5 6. Establishment and Composition of theSuomi Sakai .

The bill

is about access, equity and efficiency as well as

women, children, people with disabilities and

health financing. Everyone is well covered by

the bill and it therefore deserves presidential

assent, he said.


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Technical Committee of the National

Council

7. Functions of the Technical Committee

8. Establishment of the National Tertiary

H ospitals Commission

executives, maintained that the bill single-

handedly proposed by the Federal Ministry of

Health, infringed on their rights and vowed to8

take legal means to fight it. In addition,

Medical Laboratory scientists, under the

auspices of Association of Medical Laboratory9. Functions of the CommissionScientists of Nigeria, AMLSN, also called for

10. Establishment of Primary H ealthcarethe amendment of Section 1 of the National

Development FundHealth Bill, saying the bill in its present state

Establishment, Composition and Tenure oftook no cognisance of existing professional

the Federal Capital Territory Primary Healthregulatory laws and statutes in the health

Care Board. 14industry. Speaking to the media in Lagos,

National Secretary of AMLSN, Mr. Toyosi

Raheem, said the bill would do more harmAREAS AND ISSUES IN CO NTENTIO N

than good as it did not foster the interest of theCurrently, the NHB is stuck in the presidency

multi-professional teams within the healthwhere it has been sent to be signed, as health sector. National Secretary of AMLSNsector professionals disagree over some parts

explained that section 1 of the bill had already6-20and clauses in the Bill. Less than twenty four

disdained and prejudiced various relevanthours after the Senate passed the NHB on May 14

existing professionals.th19 2011, real war of words broke out among

professional groups and associations in theFurthermore, Raheem argued that the sub

H ealth Secto r. T hr eats were issued,section which set out the rights and duties of

ultimatums were given and the various factionshealth care providers, health workers, health8

were challenging themselves to public debates.establishments and users was not only

Already , the nurses and midwives ,ambiguous and irrelevant but also conflicts

pharmacists, technologists and radiographers,with and turns a blind eye on the existing lawsphysiotherapis ts , health informationthat established the National Council on

managers, medical scientists and others haveEstablishment whose functions and powers are

warned against the signing of the Health Bill.by law to prescribe duties and responsibilities

They began their threat with a protest march atfor all cadres of workers in the public serviceth

the Federal Secretariat on Wednesday, May 25through their various scheme of service. He

2011, after which they presented a letter to thesaid: The Bill will not only conflict with the

Head of Civil Service of the Federation,existing regulatory laws and statues, but will

Professor Oladapo Afolabi, for onwardincrease the crises in the health sector in9

transmission to President Goodluck Jonathan.Nigeria. Therefore, the victims of this crisis

shall be the innocent patients, healthcare

On May 24, 2011, Vanguard duo of Victoria professionals and the larger society that visitOjeme and Caleb Ayansina reported that the 14and patronise our healthcare facilities. The

Assembly o f H ealth care Pr ofessionalpharmacists under the umbrella of the

Associations and Unions has called onPharmaceutical Society of Nigeria (PSN) on

President Goodluck Jonathan not to give thThursday 16 June 2011 urged President

assent to the National Health Bill recentlyGoodluck Jonathan to withhold assent to the

passed by the Senate. According to the repor t,Bill until identified lapses are re-examined by

the association said there will be no peace inthe National Assembly in the interest of all

the health sector if the bill becomes law. The 13stakeholders and the public. President of

National Vice President of the Association ofPSN, Azubuike O kwor, in a press statement,

Medical Laboratory Scientists of Nigeria, Dr.said: The Pharmaceutical Society of N igeria

Godswill Okara, who spoke alongside other hereby calls on President Goodluck Jonathan



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argue that it is their traditional role to lead ato withhold assent to the Health Bill whilemedical team. The other health professionsmaking specific recommendation to theargue that they must also have a go at leadingNational Assembly to re-examine Sections 1(1)

12(6), 8(2) and 11 (2) of the Health Bill in the the commission .interest of all stakeholders and the consuming

Another controversial area in the N HB is thepublic. The PSN strongly suggests that theestablishment of the Nigerian National Health

phrase 'medical service' be replaced withSystem, according to the bill, will be the all-in-'health services' in the totality of the Health

20all as stated Part 1,Clause 1 subsection 1 thus :Bill. The PSN is of the firm conviction that theThere is hereby established for the FederationPresidency must return the Health Bill to thethe National Health System, which shallN ational Assembly to redress these lapsesdefine and provide a framework for standardsbefore assenting to the Bill. He added: It isand regulation of health services, and whichtherefore a matter of rational logic that all we

require in terms of personnel for these shall:

responsibilities are seasoned administrators ora. Encompass pub l ic and p r ivate

managers of cognate experience in publicproviders of health services;health. Running of healthcare endeavours in

b. promote a spirit of cooperation andtoday's world is akin to managing any business

endeavour and so a need arises to open up the shared responsibility among allborders of restriction in Nigeria's health providers of health services in theindustry currently led exclusively by doctors Federation and any part thereof;which only earned us a rating of 187th out of

c. provide for persons living in Nigeria191 nations whose health systems were rated in13 the best possible health services with in2000.

the limits of available resources;So the debate on the health bill is not about

how it will best affect the health of the d. set out the rights and duties of health

Nigerian people, No! There is actually no care providers, health workers, healthpretence about it it is just about the establishments and users; andprofessional tribes (or groups), and how they

e. protect, promote and fulfil the rights ofare positioned to manage 80% of the budgetary

the people of Nigeria to have access toresources on health spent on tertiary care at the

health care services.12Federal level in N igeria. The bill sets up an

This port ion of the bill is the major reason whyinnovative structure called the "Nationalso much dust is being raised by Assembly ofTertiary Hospitals Commission" (Part 1Healthcare Professional Associations andClause 8 above) to better manage the 80% of

20Unions . This subsection makes the proposedthe annual budgetary resources on health spent

NHS the alpha and omega when it comes toon t ertiary care at the Federal level in N igeria. every health decision in the nation. Currently,Now the crux of the matter holding up the billthere are numerous regulating bodies usuallyis simply on the Commission's leadership.on professional basis. For instance, medicalThe new bill states that the "Executivelaboratory practice in Nigeria is regulated byChairmanship of the proposed Nationalthe Medical Laboratory Science Council ofTertiary Hospitals Commission must be aN igeria as established by t he Medical"Medi cal D i rector of the status of a ProfessorLaboratory Science Council of Nigeria Actwith a minimum of ten years working2003. Section 4 (b) of the act empowers theexperience in a Teaching Hospi tal " Thiscouncil to: regulate the practice of Medicalclause that limits the Executive ChairmanshipLaboratory Science in Nigeria. Other

to medical doctors in perpetuity has all the professions are also backed by similar laws. Butother health professionals up in arms. Doctors



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with the National Health Bill, these regulatory Dagashi observed that the 'Free medical care

bodies would be rendered insignificant or at for children under 5 years' old, pregnant

best, impotent . An d the N H S would mothers, elderly (above 65years) and disabled20 6

coordinate and regulate everything . people' in the NH B requires deeper analysis .

'At what level of care are services going to bePart 1,Clause 1 Subsection 2 defines who will free; teaching hospitals/ federal medicalbe included in the National Health System

centres, secondary health facilities and/ orthus:primary health care. If user fees which form a

a. The National Health System shall large portion of the internally generatedinclude - the Federal Ministry of revenue that is used to take care of someHealth; overhead expenses are withdrawn from

teaching hospitals/ federal medical centres,b. (b) the State Ministries of Health inwhat will be the alternate source of funding?every State and the Federal CapitalWill the federal government increase theirTerritory ;

6monthly allocation? Our experience in many

c. parastatals under the federal and state states providing free maternal and child healthministr ies of health;

services have shown that, is not effective,d. all local government health authorities; efficient and sustainable and lacks reliable

records that maternal and under five mortalitye. the ward health committees;6

rates are reducing' he wrote . Professorf. the village health committees;

Njemanze also observed that Government

g. the private health care providers; and cannot make discretionary use of private

hospitals even in the case of emergencyh. traditional and alternative health carewithout due consent; the NHB by requiring inproviders.Part III, Section 20 (1) compulsory emergencyThis subsection does not favour other medicalcare, nationalized all private hospitals inprofessionals apart from the NMA whoseNigeria, noting that the penalty was a huge finemembers are the minister of health, state

16or imprisonment .commissioners for health, heads of health

20parastatals and other members of the NH S .

RELEVANC E AND BENEFITS O F TH EThis is seen as a calculated move by the brainsBILL IF IT BECO MES LAWbehind the bill to totally remove the inputs ofBut the Nigeria Medical Association (NMA),

other health professionals from the operationswhich was accused by the other professionals

and day-to-day running of the nation's healthof manipulating the provisions of the Health

system which according to AMLSN's Dr.Bill in favour of doctors and with the

Godswill Okara, is an orchestration of the

connivance of the Ministry of Health, hadministry and NMA who are seeking to called on President Goodluck Jonathan tolegitimize the culture of tyranny in the sector, quickly assent the NBH recently passed by theby choosing to ignore our views. But the National Assembly, urging him not to belogical question to ask is that why did they distracted by unnecessary wrangling and

9,10(other health professional groups) wait until threats by the other health professionals.the bill is passed before screaming at high The NMA President, Dr. Omede Idris, at a

th20 press conference in Abuja on Thursday 26decibels?May 2011 said the World H ealth OrganisationApart from health professional groups, othersand other bilateral organisations had lent theirhave observed areas in the passed NHB thatvoices to the passage of the bill on account of itsneed to be critically reviewed before the Bill is

inherent benefits to Nigerians.The bill issigned to Law by the President. Dr Aminuabout access, equity and efficiency as well as



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women, children, people with disabilities and the leadership role of the doctor is brazenly

health financing. Everyone is well covered by attacked by other health professionals except10

the bill and it therefore deserves presidential in Nigeria.10

assent, he said .

The Ekiti State Chapter of the NMA on JuneThe NMA described the protests by other th16 2011 also criticised the delay in signing themedical workers as unnecessary. He stated that

19NHB by President Goodluck Jonathan. Theexcept in N igeria, there was nowhere in theassociation's chairman, Dr. Kolawoleworld where the leadership role of the doctor isOgundipe, told a news conference at theso brazenly assaulted by other health careUniversity Teaching Hospital in Ado-Ekiti,professionals, regretting that immediately athe state capital, that more than six millionnew discipline was established in the healthchildren and 317,400 mothers had died sincecare sector, their next pre-occupation was tothe bill was introduced in the Nationalchallenge the leadership role of the medicalAssembly in 2005. Ogundipe said: We are notdoctor and dental professional withunaware of the actions of some groups, whichunsubstantiated claims. The reasonshave been calling on the President not to signresponsible for this unprofessional attitude andthe bill. It is difficult to understand whyunholy assault include the inordinate,anyone interested in making health available tounethical and crass political ambition of someall Nigerians will go against the assenting of theprofessional groups. Ethically, it is unarguablebill. He said the NHB would give the poorthat the medical doctor is the leader of theaccess to quality health care, giving preferencehealth team. This is the norm globally, Dr.

9 to expectant mothers, motherless babies,Idris added. He also submitted that the bill didphysically challenged and other vulnerablenot abrogate any of the laws of the regulatory

19people.bodies, including the Medical and Dental

Council of Nigeria which regulates the Also in Benin City, a former Commissioner10

practice of medicine and dentistry in Nigeria . for Health in Edo State, Dr. Wilson Imogan,thHe added that the opposition to the bill by on July 24 2011 appealed to Presidentparamedical association was because the Goodluck Jonathan to assent to the NHBassociation did not want patients and clients to passed by the National Assembly, to save the

18know their rights. The fear of conflicts with lives of Nigerians. He said that the bill asthe N ational Health Bill to a curious mind may passed by the N ational Assembly would assistmean the paramedical laws ab initio are in the coordination of health care services indefective and faulty. Standard setting is the country because it gave Nigerians theresponsibility of government and the relevant power to seek for good and qualitative healthprofession, while regulatory body regulates its care. Imogan said the bill provided themembers, he said. However it does appear opportunity for patients to have details of the

the paramedical professionals do not want the treatment being administered on them and tousers, that is, patients and clients to know their sue when they suspect foul play. I believe thatrights. Do they really mean well for the health of health is a human right and if you go through

Nigerians? The bill did specify the the bill, it created the opportunity forqualifications and experience of such medically Nigerians to have good health care for the firstqualified doctor to drive the process. Do the time. Therefore, if there are gray areas, we

paramedical professionals equally want to take expect that these can be addressed inover hospital services division? Idris subsequent amendments. If there arewondered why the paramedical professionals objections to clauses in the document, thewould want to take a centre stage in a National Assembly remains the only body toprofession where they were helpers, insisting make that amendment. Don't forget that our

that there was no other part of the world where constitution was amended twice within a



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18 healthsector,allprofessionalsmustagreetoit,monthbecausetherewasneedforit .ratherthanthesituationwheresomeperceive

InanopenlettertoPresidentJonathanonJulyt h at t h e Bill as m ar gin alisin g t h eir th

29 2011requestingforhisassenttothepassedprofessions....Jonathanoughttoseekmeansof

N HB,H ealthReformFoundationofN igeriaassuaging the feelings of those aggrieved by7

(H EFRON)wrote :- controversialsectionsoftheBillbyfindinga

' Mr. President, weknow that you areaware middlegroundevenifitmeanshisseekingan

thattheN BH providesfor: amendmentoftheBill' .Dr.AdedamolaDada,

formerChairmanoftheLagosStateBranchof! FreeMedicalCareforchildrenunder5

N MAsaidthatalthoughtheBillisnotperfect,years old, pregnant mothers, theithasalotofbenefitsforthecommonmanandelderly(above65)anddisabledpeople.shouldbeassentedto by President Jonathan.

! A guaranteed basic minimum health H esaiditwasbetterfortheBilltobeendorsedpackageforallN igerians firstandlateramended,justliketheN ational

H ealth InsuranceSchemewhich most people! Universalacceptanceofaccident casesdidnotagreewiththeprovisionsbeforeitwasby all H ealth facilities in N igeriaassentedto.H efurthersaidthatifwecontinue(PublicandPrivate)waitingforalltoagreeontheprovisionsofthe

! Ensuredquality ofhealthcareservicesN HB, therewill beno Bill at theend ofthe

throughtheissuanceofCertificatesof 23day .

Standard(PublicandPrivate).th

AlsoonThursdayJuly28 2011,theMinisterThesewillresultinimprovedhealthoutcomes

of H ealth, Prof. Christian Chukwu, blamedand better quality of life for all. The Bill

whathedescribedasnoticeablegapsaswellasprovides a fundamental shift in the way

objections raised by health workers for thehealthcareserviceswillbegoverned,planned,

delayingettingPresidentGoodluckJonathanresourced, delivered and monitored. It deals 17toassenttotheN HB. H esaidassoonasthesquarely with the N igerian health questions

Presidentialteamsetuptolookintoconcernsandpriorities....WeknowSir,thatyoumade

raised was able to resolve the issues, thecommit men t t o sign t h e bill t o t h e

Presidentwouldsignitintolaw.TheministerinternationalcommunitythroughtheBritish

saidthebillneededtobeassentedtoinorderPr ime Min ist er , David C amer on , t h e

17,23not to stifle the growth of the sector.

SecretaryGeneralofUnitedN ational-BanKi-PresidentGoodluckJonathanrecentlysetupamoon.Mr.PresidentSir,theN igerianH ealth43-man Committeeunder theChairmanshipsectorreformcoalitionherebycallsonyoutoof Justice Bello Gusau to resolve theassent to the health bill without further

237 controversialareasintheN HB .

delay' . H ajiaBilkisu(mni)oftheCivilSociety21Watchalsowrote ...' MrPresident,pleasesign Finally,theLancetinaneditorialontheN HB

1inJune2011wrotethus :theBill.WhileIdonotexpecttheBilltosolve

allthehealth problemsofN igerians,Iknow' &OnMay 29, many N igerians celebrated

thattheN HBwillsurelyaddressthegapsandagain as D r G oodluck Jon at han was

ach ieve im pr o ved r esu lt s wit h go o dinauguratedasPresident for thenext 4years.

governanceandafocussedleadershipdevoidofThe zoologist succeeded President Umaru

corruption' .Yar' Adua after his death last year, and in

April,2011,Jonathanwasre-electedinwhatisIn her review on theN HB, Kemi Yesufu of22

Daily Independent N ewspaper wrote .... widely considered the most transparent and

' manyareoftheviewthatfortheBilltobring legit imat e elect ion N iger ia ever held.about the much touted transformation to H owever, until now, healt h has been



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lamentably absent from Jonathan's declared Bill. A 43-man presidential committee has been

priorit ies. Although progress has been made in set up to look into the concerned raised and

poliomyelitis eradication and health-systems resolve the issues, after which the President is

strengthening since he came to power in May, expected to sign the NH B into Law. The NHB

2010, these are only two of hundreds of contains some good innovations, such as the

indicators in dire need of improvement. Many establishment of the National Primary Health

societal groups grew concerned over his Care Development Fund and National

neglect of a health agenda.... At the time of Tertiary H ospitals Commission. Once the

going to press, all that remains outstanding is NHB is signed into law, it becomes an act that

presidential assent to make the NHB a federal provides a framework for the regulation,

law. This auspicious turn of events gives cause development and management of the national

for hope. Perhaps President Jonathan is more health system and set standards for rendering

devoted to rectifying the appalling state of health services in the federation, and other

health in Nigeria than has been apparent thus matters connected therewith.

far. If he really is committed to providing

equitable and affordable universal health care RECOMMENDATIONSfor all of his people, he should sign the NH B 1. There is the need for future periodic

immediately. There is no better way to say review of the passed N HB, when signed

thank you for electing him.' into Law, to accommodate changing

challenges that will be facing Nigerian

CONCLUSION H ealth Care Delivery System.There is a delay of presidential assent to the 2. The NHB should be faithfully and

finally passed N ational H ealth Bill mainly honestly implemented when it

becomes an Act so as to enablebecause of disagreement among health sectorNigerians benefit from its manyprofessionals on some parts and clauses in the

JOURN AL OF CO MMUN ITY MEDICIN E AND PRIMARY H EALTH CARE VOL. 23, NO S 1&2, MAR/ SEPT, 2011 8

Documents

The Nigerian National Health Bill 2011: Delay of Presidential Assent to an Act: Issues Arising