Federal Health Ministry

By Lawal Dahiru Mamman

It is not uncommon to see destitute in motor parks, religious centres, T-junctions and other places that pull crowds clutching a doctor’s prescription, soliciting public support to purchase drugs.

Others plead not to be offered money but instead be accompanied by any good samaritan to the nearest pharmaceutical outlet to purchase the medication on their behalf. This is to free them from the accusation of preying on public emotion to beg for money without any justifiable reason.

These are indications that a number of Nigerians cannot afford drugs to treat themselves owing to the fact that healthcare is predominantly financed by households, without government support. According to pundits, this, among other factors, has been instrumental in pushing many citizens into poverty.

In 2021, the World Health Organization (WHO) said, “Up to 90 per cent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realised in practice.

“Besides the prioritising of services for poor and vulnerable populations, supported through targeted public spending and policies that protect individuals from financial hardship, it will also be crucial to improve the collection, timeliness and disaggregation of data on access, service coverage, out-of-pocket health spending and total expenditure.

“Only when countries have an accurate picture of the way that their health system is performing can they effectively target action to improve the way it meets the needs of all people.”

WHO revealed during the 6th Annual Conference of the Association of Nigeria Health Journalists (ANHEJ) last year in Akwanga, Nasarawa State, that “With healthcare out-of-pocket expenditure at 70.5 per cent of the Current Health Expenditure (CHE) in 2019, general government health expenditure as a percentage of the GDP was 0.6 per cent while government expenditure per capita was $14.6 compared with WHO’s $86 benchmark for universal health coverage (UHC).”

Nigeria currently bears the highest burden of tuberculosis and paediatric HIV while accounting for 50 per cent of neglected tropical diseases (NTD) in Africa, contributing 27 per cent of global malaria cases and 24 per cent of global deaths with Non-communicable Diseases (NCDs) accounting for 29 per cent of all deaths in Nigeria with premature mortality from the four main NCDs (Hypertension, Diabetes, Cancers, Malnutrition) accounting for 22 per cent of all deaths.

On account of the high disease burden, high out-of-pocket health expenditure and low enrollment into the NHIS, now National Health Insurance Authority (NHIA), the Federal Ministry of Health and Social Welfare has unveiled operational guidelines for the NHIA to ensure financial access to quality healthcare in line with Sustainable Development Goals, (SDGs), consequently putting the country on track of attaining Universal Health Coverage (UHC).

The Ministry said, “High out-of-pocket payment for health care services is not good enough, and it is not sustainable. Only 9 per cent of Nigerians have insurance coverage, and 90 per cent don’t.

“Ill health is pushing many Nigerians into poverty. We must, therefore, change the trajectory of healthcare delivery in Nigeria.

“Many people have wondered why the President added social welfare to the Ministry of Health. The answer is health insurance. Health insurance is the key to the Renewed Hope Agenda, and it is the reason the President added social welfare to the Ministry. This is because the President is aware that we need social protection for our people.”

The guideline, which harmonised crucial provisions of the old operational guidelines with the new Act, provided a legal basis for mandatory participation by all Nigerians, the Vulnerable Group Fund (VGF) for citizens who are able to service their insurance after keying-in and empowered the NHIA to promote, regulate and integrate health insurance schemes in the country among other provisions of the Act so as to contribute to poverty reduction as well as socioeconomic development.

The review expanded the operational guidelines from four to five. The first section, Governance and Stewardship, provides, which was not part of the previous guideline, a broad overview of the roles and responsibilities of the NHIA and stakeholders within the insurance ecosystem.

The second section, schemes and programs, identified contributory, non-contributory and supplementary/complementary schemes to ensure the capturing of public and private sector employees, a vulnerable group including those not captured in the National Social Register (NSR) by pooling resources from government, private sector, philanthropist and even international organisations.

Standards and accreditation, which is the third section, will focus on bringing health workers, health facilities and equipment, and patients under one roof for the meticulous running of the NHIA.

The fourth section of the operational guidelines, data management, allows the NHIA to provide and maintain information for the integration of data health schemes in Nigeria. Such data will allow collaboration data sharing between facilities, medical audits, and research and aid seamless decision-making for the authority.

Offences, penalties and legal proceedings, which is the last of the guidelines, ensures stakeholders’ compliance with the provision of the NHIA and provide a legal instrument for the investigation of grievances and disputes between stakeholder in accordance with protocols of the NHIA.

Implementation of this effort by the Health Ministry will make Nigerians worry less about the financial consequences of seeking medical care, providing avenues for early detection and treatment of diseases, which in turn will guarantee a healthy citizenry and increase population health outcomes for national growth and sustainable development.

Lawal Dahiru Mamman writes from Abuja and can be reached via dahirulawal90@gmail.com.

By Ibrahim Ahmad Kala, LL.M

“NDLEA seizes 48,000 Tramadol tabs, 22 UK, France, Portugal passports” – Punch, January, Monday 31st, 2022;

“NDLEA arrests Indian businessman for ‘smuggling 134,700 bottles of codeine”- The Cable of February 13, 2022;

“NDLEA Nabs Suspected Drug Baron Behind N3bn Tramadol Linked To Abba Kyari’s Team” – Channel news, Monday, April 25, 2022.

“NDLEA seizes 1.1 tonnes of Tramadol, 396 kg of codeine syrup in Kaduna” – NewsDirect -April 28, 20220;

“NDLEA uncovers N22bn worth of Tramadol after arrest of Abba Kyari’s accomplice” – Daily Nigeria May 3, 2022; and

“NDLEA Seizes 34,950 Tramadol, Diazepam Capsules Enroute To Boko Haram” – Daily trust, Saturday 5th June, 2021.

The above are some of the recent striking headlines that often hit the news stands in both the online and mainstream media in respect of the Federal Government effort to arrest the rampant abuse of what are termed as “controlled” or “restricted” over-the- Counter (OTC) drugs in the country.

According to Wikipedia, OTC drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription.

Such OTC drugs include Codeine, Tramadol, Diazepam and all other Analgesics within their genre. The 2020 Nigeria Essential Medicines List, 7th Edition issued by the Hon. Minister of Health, Dr. Ehanire Osagie, restricts the usage of such Narcotic analgesics.

Their restrictions is no doubt connected with their common abuse nowadays in various ways that range from abortion ro sexual enhancement, from halluscination to crimes aiding tranquilizers.

It is therefore, evident that these OTC drugs have outlived their usefulness because of the growing number of Nigerians involved in the production, distribution, its use and abuse, and its consequencal effects such as increase in the likelihood of violent behavior and crime, stroke, mental disorder and brain damage.

However, the drugs control laws and policy have not produced the desired result of curbing the production, trafficking and abuse of these dangerous drugs and substances. To be specific, all these OTC drugs which are mostly Narcotic analgesics being usually prescribed by medical officers for the treatment of mild and severe pain to patients across the country, but now abused by unscrupulous few in the society, have not been clearly proscribed, criminalized, banned, and or outlawed.

The Minister, via his administrative fiat or directive, merely restrict and controlled its sale and usage. The ineffectiveness of the country’s drug laws and policy may be attributed to several factors one of which is that the drug policy and laws are formulated and implemented without the benefit of rigorous knowledge, research and review on them, and their effective enforcement.

For instance, the highbrow grains of Section 19 of the NDLEA Act, Cap. N30, LFN, 2004 – the principal drugs legislation where most drugs charges in courts basically drive its validity and vitality provides as follows: “Any person who, without lawful authority, knowingly possesses the drugs popularly known as cocaine, LSD, heroine or any other similar drugs shall be guilty of an offence under this Act and liable on conviction to be sentenced to imprisonment for a term not less than fifteen years and not exceeding 25 year”.

This section, as faulty and inadequate as it is, has been X-rayed by Nigerian Courts in plethora of cases, exposing the futile attempt by the NDLEA to bring within its fold, such Narcotic analgesics in the category of Tramadol, Diazepam and Codeine that do not fall within the category of negative drugs popularly known as cocaine, LSD, heroine within the ejesdem rule of “or any other similar drugs” stated in section 19 of the NDLEA Act.

This indeed, serves as escape route for drugs cartels to go unpunished in the aftermath of their trial in such drugs related cases. That is why whenever I see these headlines that a person is arrested in possession of these so called “controlled” or “restricted” drugs, I shrug in disapproval, having known very well that such person(s) would never be found guilty of what has never been criminalized in the country.

That section 19 of the Act seems to have created micro elements of the drugs offence, apart from the basic criminal elements of actus reus and mens rea. Namely: i. being knowingly in possession; ii. Without lawful authority; and iii. The drug being confirmed a prohibited or controlled drug. See Ugochukwu v. FRN (2016) LPELR – 40785 (CA).

These micro essential elements of the offence were later held in Eze v. FRN (2018) LPELR – 46112 (CA) to be four, namely; 1. The Defendant was found in possession; 2. The Defendant possess the drugs without lawful authority; 3. The Defendant has the knowledge of the substance in possession to be drugs; and 4. The drugs are proved to be cocaine, LSD, heroin or any similar drugs. See also Ugwanyi V. FRN (2013) All FWLR (Pt. 662) 1655 @ p. 1664.

However, such bifurcation of the ingredients from 3 to 4 is understandably for more elaboration, which does not wear away the substance and efficacy of the section under the Act. These ingredients have to be proved conjunctively to sustain a charge against the Defendant under the Act.

The one that is vital to my point among these micro elements, is “the drug being confirmed a prohibited or controlled drug” or “the drugs are proved to be cocaine, LSD, heroin or any similar drugs.”

This particular element embedded in section 19 of the Act was espoused in the case of Emeka Eze v. FRN (supra). Here the Appellant had made his way to Jimeta Modern Market to collect a consignment of goods comprising of 4 cartons of Tramadol. In the process of evacuating the goods, he was confronted by the officers of NDLEA, who, acting on information, arrested him and seized the cartons.

He was later charged under section 19 of NDLEA Act, but he argued that Tramadol has not been criminalized in Nigeria. While agreeing with the Appellant, the court held that Tramadol does not fall within the ejusdim genre classes of “any other similar drugs” negative to the ones such as cocaine, heroine and LSD listed under section 19 of the NDLEA Act, and the fact that it’s been abused by unscrupulous few people in the society does make its possession and usage illegal.

A drug being merely controlled or restricted without more is not illegal. Consequently, the Appellant was discharged and acquitted.

All I am saying is that category of narcotic analgesics such as Tramadol, Diazepam and Codeine that bring more harm than relief to our youths should be specifically banned and criminalized in the country having outlived their usefulness. New alternatives may be offered that have little or no narcotic effects on the health and well-being of the citizens.

Indeed, the essence of this piece is to celebrate the International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, though belated, which was marked on 26th June every year, to strengthen action and cooperation in achieving the goal of a world free of drug abuse.

Ibrahim Ahmad Kala, LL.M can be reached via Ibrokalaesq@gmail.com