The Nigerian Medical Association (NMA) is deeply concerned about the reported proposal by the Senate of the Federal Republic of Nigeria to introduce stiffer penalties, including imprisonment and fines, for health workers who reject patients requiring emergency medical attention.
While we fully recognise and support the fundamental principle that every patient deserves access to emergency medical care, irrespective of their financial status or ability to make immediate payment, we believe that the proposed legislative intervention, if pursued without first addressing the underlying challenges confronting our healthcare facilities, would amount to putting the cart before the horse.
The National Health Act (NHA) already provides a legal framework for the protection of patients requiring emergency medical treatment. The existing provisions prohibit the refusal of emergency medical care. The critical question, therefore, is not necessarily the absence of legislation but the failure to implement existing provisions and create the enabling environment for their effective execution.
Of particular importance is Section 6 of the National Health Act, which establishes the Basic Health Care Provision Fund (BHCPF) and provides for the funding of emergency medical treatment. This provision recognises that emergency care requires financial support and that healthcare facilities must not be left to bear the cost of providing such services without appropriate reimbursement.
Unfortunately, the implementation of this aspect of the BHCPF remains inadequate. Hospitals and healthcare facilities that have provided emergency treatment, often at considerable financial cost and sometimes at the expense of their already overstretched resources, are unable to access the expected refunds or reimbursement. This creates an unsustainable situation in which hospitals are expected to provide emergency care without the necessary financial support.
It is fundamentally unfair to impose criminal liability on healthcare workers and hospitals for failing to deliver services when government has not fulfilled its corresponding responsibility to provide the resources and enabling environment required for such services.
Beyond the funding challenges, Nigeria is confronted with a scandalous shortage of doctors and other healthcare professionals. This is largely attributable to poor remuneration, unfavourable working conditions, inadequate infrastructure, insecurity, excessive workloads and the general lack of an enabling professional environment. These challenges have fuelled the alarming emigration of Nigerian doctors and nurses to other countries, including neighbouring African countries where conditions of service are increasingly more attractive.
Our hospitals are consequently operating with dangerously inadequate manpower. In several facilities, the few available doctors are expected to manage overwhelming patient loads, sometimes under extremely difficult circumstances and without adequate support.
Even more disturbing is the deplorable state of infrastructure and the persistent shortage of essential medical supplies in many of our hospitals. Basic emergency-care requirements, including oxygen, essential drugs, blood and blood products, resuscitation equipment, consumables, functional ambulances and other life-saving facilities, are not readily available in many healthcare institutions.
How can we reasonably expect a doctor to provide emergency care when the hospital lacks the basic equipment, drugs and consumables required to save a life? How can we threaten health workers with imprisonment for circumstances that are substantially beyond their control?
The NMA strongly believes that the priority of the National Assembly should be to address these fundamental systemic deficiencies rather than introduce punitive measures that may further demoralise an already distressed healthcare workforce.
We therefore call on the Senate and, indeed, the National Assembly to prioritise the following:
- Effective implementation of the National Health Act and the BHCPF: Government should ensure that the emergency medical treatment provisions are fully implemented, with transparent, accessible and timely reimbursement mechanisms for hospitals that provide emergency care.
- Improvement of healthcare infrastructure: Federal and State Governments must urgently equip hospitals with functional emergency units, oxygen supply systems, essential drugs, consumables, diagnostic equipment, blood banks and other critical life-saving resources.
- Addressing the acute shortage of healthcare professionals: There must be deliberate and sustained investment in the recruitment, retention and equitable distribution of doctors, nurses and other healthcare professionals across the country.
- Improvement of conditions of service: Government must address poor remuneration, welfare, working conditions, excessive workloads, inadequate staffing, insecurity and other factors driving the mass emigration of Nigerian health professionals.
- Protection of healthcare workers: Healthcare professionals must be provided with safe working environments and adequate institutional support to enable them to discharge their professional responsibilities without intimidation, harassment or threats of criminal prosecution for systemic failures.
- Stakeholder engagement: The Senate should engage the NMA, other health professional associations, healthcare facility managers and relevant stakeholders before considering any amendment to the National Health Act that imposes additional criminal liability on healthcare workers.
- Clear distinction between professional misconduct and systemic failure: Where there is demonstrable, deliberate and unjustifiable refusal to provide emergency care despite the availability of the necessary personnel, facilities and resources, appropriate professional and legal sanctions may be warranted. However, criminal liability must not be imposed indiscriminately on health workers who are themselves victims of systemic deficiencies.
The NMA wishes to emphasise that doctors are trained, professionally obligated and ethically committed to saving lives. No doctor takes pleasure in watching a patient die, particularly when such a death could have been prevented. However, professional commitment cannot substitute for absent infrastructure, unavailable medicines, inadequate manpower or an unfunded healthcare system.
The proposed amendment, if implemented in isolation, risks criminalising the victims of a dysfunctional healthcare system rather than addressing those responsible for its dysfunction. It may further heighten frustration, erode professional morale and accelerate the already alarming emigration of doctors and nurses from Nigeria. This would ultimately worsen access to emergency medical services and expose more Nigerians to avoidable deaths.
The Senate must understand that you cannot legislate your way out of a healthcare crisis by threatening the very professionals expected to manage it. Laws imposing obligations must be accompanied by the resources, infrastructure and institutional support necessary to fulfil those obligations.
The NMA is not opposed to legislation that protects patients or promotes accountability in healthcare delivery. On the contrary, we strongly support measures that guarantee every Nigerian access to safe, timely and quality emergency medical care. However, accountability must be equitable, evidence-based and accompanied by corresponding government responsibility.
Our position is simple: Make our hospitals functional, adequately fund emergency care, provide essential drugs and equipment, recruit and retain sufficient healthcare professionals, improve their conditions of service and guarantee their safety. Then insist on accountability.
The lives of Nigerians must be protected, but the professionals entrusted with saving those lives must also be protected, supported and adequately equipped.
We urge the Senate to reconsider the proposed amendment in its present form and redirect its legislative energy towards addressing the fundamental challenges undermining emergency healthcare delivery in Nigeria.
A functional healthcare system, not the threat of imprisonment, is the most sustainable way to ensure that no Nigerian is denied life-saving emergency medical care.
Signed,
Dr. (Prof.) Afekhide Ernest Omoti
President, Nigerian Medical Association (NMA)