The Healthcare Providers’ Association of Nigeria (HCPAN) has formally petitioned the National Assembly to withdraw the proposed National Health Facility Regulatory Agency of Nigeria (NHFRA) Bill, arguing that the establishment of a new regulatory body would lead to redundant administrative layers, escalate the cost of medical services, and further complicate the nation’s already strained healthcare delivery system. As the primary umbrella organization representing private healthcare providers across the federation, HCPAN’s opposition marks a significant development in the ongoing legislative debate surrounding the governance of Nigeria’s medical infrastructure.

The association articulated its position during a comprehensive press briefing held in Lagos, which followed the submission of a detailed memorandum to the Senate Committee on Health during a recent public hearing. The leadership of HCPAN clarified that while they remain steadfast supporters of high-quality healthcare and rigorous standards, they believe the NHFRA Bill is a counterproductive approach to achieving those goals. Instead of fostering efficiency, the association warns that the bill would create a bureaucratic bottleneck by duplicating the functions of several existing statutory bodies.

The Core Arguments Against the NHFRA Bill

At the heart of the controversy is the concern over regulatory overlap. Dr. Austine Aipoh, the President of HCPAN, highlighted that the proposed agency’s mandate—which includes inspecting, accrediting, certifying, monitoring, and sanctioning healthcare facilities—is already being performed by a multitude of established institutions. These include the Federal Ministry of Health and Social Welfare, various State Ministries of Health, and the National Health Insurance Authority (NHIA).

Furthermore, professional regulatory councils already possess the legal authority to oversee the facilities where their members practice. Dr. Aipoh pointed out that the Medical and Dental Council of Nigeria (MDCN), the Pharmacy Council of Nigeria (PCN), the Nursing and Midwifery Council of Nigeria (NMCN), and the Medical Laboratory Science Council of Nigeria (MLSCN) all maintain rigorous standards for the operation of clinics, pharmacies, and laboratories.

The introduction of the NHFRA would, in effect, subject a single private hospital or diagnostic center to multiple inspections from different federal and state agencies, each requiring its own set of paperwork, accreditation processes, and, perhaps most critically, regulatory fees. HCPAN argues that this "regulatory congestion" does not translate to better patient safety but instead creates an environment of administrative exhaustion for healthcare providers who are already struggling with the country’s current economic challenges.

Economic Implications and the Burden on Patients

Nigeria’s healthcare sector is currently grappling with significant headwinds, including the mass exodus of medical professionals—often referred to as the "Japa" syndrome—and the soaring costs of medical equipment and pharmaceuticals due to currency fluctuations. HCPAN asserts that adding another layer of regulatory fees and compliance costs would inevitably be passed down to the patients.

"Rather than simplifying healthcare regulation, the Bill risks creating an additional layer of bureaucracy that will increase compliance costs without necessarily improving patient outcomes," Dr. Aipoh stated. He emphasized that in a country where out-of-pocket expenditure remains the primary means of accessing healthcare for the vast majority of citizens, any policy that increases the operational costs of private providers is a direct threat to healthcare affordability and accessibility.

The association’s analysis suggests that if the NHFRA Bill is enacted in its current form, small to medium-sized healthcare facilities—which provide the bulk of primary and secondary care in urban and rural areas—could face financial insolvency. The cumulative weight of federal taxes, state levies, professional council dues, and now potential NHFRA fees could force many providers to downsize or close entirely, further widening the gap in Nigeria’s healthcare coverage.

Chronology of the Legislative Dispute

The movement to establish the National Health Facility Regulatory Agency has been gaining momentum within the halls of the National Assembly over the past year. Proponents of the bill argue that a centralized agency is necessary to harmonize standards across all 36 states and the Federal Capital Territory, ensuring that a patient in a rural clinic receives the same quality of care as one in a metropolitan hospital.

The timeline of recent events leading to HCPAN’s public stance is as follows:

• Initial Drafting: The NHFRA Bill was introduced as a means to address perceived gaps in the monitoring of private and public health facilities.
• Senate Committee Referral: The bill was referred to the Senate Committee on Health for detailed scrutiny and stakeholder engagement.
• Public Hearing: In mid-2024, the Senate Committee held a public hearing where various stakeholders, including the Ministry of Health and professional bodies, presented their views.
• HCPAN Memorandum: During the hearing, HCPAN submitted a formal memorandum outlining the dangers of regulatory duplication.
• Lagos Press Briefing: Following the hearing, HCPAN convened its members and the media in Lagos to amplify their concerns and call for a total withdrawal of the bill.

The Oronsaye Report and the Call for Lean Governance

The HCPAN’s opposition to the NHFRA Bill aligns with a broader national conversation regarding the cost of governance in Nigeria. Critics of the bill have pointed to the landmark Oronsaye Report, which recommended the merging of several government agencies to reduce waste and eliminate functional overlaps.

By proposing a new agency, the National Assembly appears to be moving in the opposite direction of these recommendations. HCPAN members argue that the resources intended for the establishment of the NHFRA—including the budget for office space, staff salaries, vehicles, and equipment—would be far more effective if redirected toward strengthening the existing regulatory bodies.

"The focus should be on capacity building for the MDCN, PCN, and State Ministries of Health," said a representative from the Association of Community Pharmacists of Nigeria (ACPN), which has thrown its weight behind HCPAN. "We do not need more agencies; we need our current agencies to be better funded, digitized, and more collaborative."

Proposed Alternatives: A Coordination Framework

Instead of creating a new entity, HCPAN has proposed the development of a "National Healthcare Regulatory Coordination Framework." This framework would aim to harmonize the activities of existing institutions, eliminate overlapping responsibilities, and encourage joint inspections.

Under this proposed model:

1. Joint Inspections: Rather than five different agencies visiting a hospital at five different times, a single, multi-disciplinary team representing various councils and the Ministry of Health would conduct a comprehensive annual audit.
2. Digitization: A centralized digital portal would be created where healthcare providers can upload their credentials and pay all regulatory fees in a single transaction, with the funds then distributed to the respective councils.
3. Standardization: The Federal Ministry of Health would set the national benchmarks, while State Ministries and professional councils would handle the direct enforcement, avoiding the federal-state jurisdictional conflicts that the NHFRA Bill might trigger.

Broader Impact and Stakeholder Unity

The pushback against the NHFRA Bill is not limited to hospital owners. It represents a unified front across the private healthcare value chain, including laboratories, diagnostic centers, and pharmacies. The ACPAN and other professional groups have warned that the bill could inadvertently grant the new agency powers that conflict with the statutory mandates of professional councils established by the Nigerian Constitution and other extant laws.

They argue that healthcare concerns are universal, as every citizen is either currently a patient or a potential patient. Therefore, any legislation that threatens the viability of healthcare providers is a matter of national security and public interest.

HCPAN, which has been a voice for private healthcare establishments since 2004, reaffirmed its commitment to working with the National Assembly and the Federal Ministry of Health and Social Welfare. However, the association remains firm that the NHFRA Bill, in its current iteration, is not the solution to Nigeria’s healthcare challenges.

As the Senate Committee on Health reviews the testimonies and memoranda from the public hearing, the medical community waits to see if the legislature will heed the warnings of the providers on the front lines. The outcome of this legislative battle will likely determine the regulatory landscape of Nigerian healthcare for decades to come, balancing the need for oversight with the necessity of maintaining an affordable and functional private health sector.