In July 2018, Vice President Yemi Osinbajo launched the Patients’ Bill of Rights (PBoR).
The event at the State House Conference Centre, Abuja,.organised by the Consumer Protection Council (CPC), was attended by critical stakeholders in Nigeria’s health sector, including the Nigerian Medical Association (NMA).
PBoR is an aggregation of patients’ rights that exist in other instruments including the 1999 Constitution, Consumer Protection Act, Child Rights Act, Freedom of Information Act, National Health Act, and other sundry regulations.
PBoR was developed by the Consumer Protection Council (CPC) and other stakeholders including the Federal Ministry of Health for the protection of consumers.
At the event, Mr Osinbajo said: “Today, we take a definite step in ensuring peoples’ rights in the healthcare sector, which are truly respected and protected in part because no one in our country is insulated or immunised from needing medical services. Essentially, our comfort, lives and life expectancy are in part determined by the quality and delivery of healthcare services.
Speaking about the imperative of the bill in Nigeria, Mr Osinbajo cited the dim view of Nigerians on the country’s healthcare system.
He said: “A 2016 study by PwC [Price Waterhouse] revealed that 90 per cent of respondents associate healthcare in Nigeria with low quality, while over 80 per cent and over 70 per cent respectively, associate it with words like `rude’ and `fear’. Conversely, less than 20 per cent felt that the healthcare provided in Nigeria gave value for money, and less than 10 per cent felt that it was transparent.”
Similar to the PwC study, a report last year by PREMIUM TIMES quoted pregnant women in an Abuja per-urban community expressing a preference for traditional birth attendants over midwives at primary health care facilities. The women said the traditional birth attendants are less aggressive than the over-worked healthcare providers in dilapidated community facilities.
Run-down health facilities staffed by rude health workers are a violation of the right of citizens to health, a fundamental human right.
The World Health Organisation (WHO) in 1946 defined the right to health as “the enjoyment of the highest attainable standard of health” that should be available, physically and economically accessible, acceptable by medical ethics standards and of quality to all; regardless of race, religion, political belief, economic or social condition.”
The subject of rights in healthcare are relevant today as they align with the global movement towards Universal Health Coverage (UHC). The UHC requires that health services are available for all.
A former High Commissioner for Human Rights, Mary Robinson, explained that “the right to health does not mean the right to be healthy, nor does it mean those poor governments must put in place expensive health services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans, which will lead to available and accessible health care for all in the shortest possible time.”
The right to health consists of freedoms and entitlements. Freedoms to control bodily integrity and the right to be free from non-consensual medical treatment and experiments. Entitlement to the right to a system of health protection, preventive measures, treatments and control of diseases and access to essential medicine.
According to the WHO, “Understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing (sic) for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality.”
This is also important as rights to health are prerequisites for other rights. The Office of the United Nations High Commissioner for Human Rights (OHCHR) states that “When the rights to health are upheld, their access to all other human rights is also enhanced, triggering a cascade of transformative change”.
The Right to Health is enshrined in the Patients’ Bill of Rights as well as in the National Health Act of 2014 and in the Constitution of Nigeria. Chapter II of the Constitution in Section 17 (3) (d) which lists the Objective and Directive Principles of State Policy, noted that the State shall direct its policy towards ensuring that “there are adequate medical and health facilities for all persons.”
This is also recognised in Chapter IV, which lists fundamental rights. Section 33 and Section 34 reference the right to life and dignity, respectively.
Indeed, being unhealthy comes at the expense of these fundamental rights including the right to life. Human rights cannot be actively exercised without health and indeed health cannot be attainable without dignity that is upheld by all other human rights. In this regard, the Nigerian National Health Act 2014 in Part 1 (1) (c) states that governments have to “provide the best possible health services.”
As Nigeria introduced the Patients’ Bill of Rights, health professional associations, ordinary citizens, the media and human rights associations were eagerly awaiting the government’s leadership and detailed plans to operationalise this important legal instrument.
About nine months after the launch of the bill, however, there is little public information about how the Consumer Rights Protection Council will implement these rights, how citizens can pursue redress and how the public health care system can reorient its practices to deliver health as a right.
All the 12 health rights enshrined in the Bill of Rights are important and must be protected. These rights are:
- Right to relevant information in a language and manner the patient understands including diagnosis, treatment, other procedures and possible outcomes.
- Right to timely access to detail and accurate medical records and available services.
- Right to transparent billing and full disclosure of any costs, including recommended treatment plans.
- Right to privacy, and confidentiality of medical records.
- Right to clean, safe, and secure healthcare environments.
- Right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstances.
- Right to receive urgent, immediate and sufficient intervention and care, in the event of an emergency.
- Right to reasonable visitation in accordance with prevailing rules and regulations.
- Right to decline care, subject to prevailing laws and upon full disclosure of the consequences of such a decision.
- Right to decline or consent to participate in medical research, experimental procedures or clinical trials.
- Right to quality care in accordance with prevailing standards.
- Right to complain and express dissatisfaction regarding services received.
Currently, however, SERVICOM is providing some mechanisms and opportunities for redress for violations of health care rights.
But stakeholders said the government needs to strengthen interagency coordination of SERVICOM, the Consumer Rights Protection Council, the Ministry of Justice, the Federal Ministry of Health as well as the Ministry of Women’s Affairs. They also want it to increase knowledge about the bill, equip public facilities for responding to it and to lay out a framework for obtaining redress for violations.