The Healthcare Providers’ Association of Nigeria (HCPAN) has formally called upon the National Assembly to withdraw the proposed National Health Facility Regulatory Agency of Nigeria (NHFRA) Bill, cautioning that the establishment of a new regulatory body would lead to a counterproductive duplication of functions, escalate the cost of medical services, and further complicate the delivery of healthcare across the federation. As the primary umbrella organization representing private healthcare providers in Nigeria—including hospitals, clinics, diagnostic centers, laboratories, and pharmacies—HCPAN voiced these concerns during a comprehensive press briefing held in Lagos. This public stance follows the association’s recent submission of a detailed memorandum to the Senate Committee on Health during a public hearing on the proposed legislation.
The association’s leadership emphasized that their opposition to the Bill is rooted not in a resistance to regulation or oversight, but in a desire for a more streamlined, efficient, and coordinated regulatory environment. According to HCPAN, the current Nigerian healthcare landscape is already governed by numerous statutory bodies, and adding another layer of federal bureaucracy would likely stifle the private sector, which currently provides over 60 percent of the healthcare services accessed by the Nigerian population.
The Core Arguments Against the NHFRA Bill
Speaking on behalf of the association, HCPAN President Dr. Austine Aipoh articulated that the proposed agency’s mandate would directly overlap with the existing responsibilities of several established regulatory entities. 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—such as 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)—already possess the statutory power to inspect and certify the professional standards of facilities within their respective purviews.
Dr. Aipoh noted that while HCPAN remains a staunch supporter of initiatives aimed at improving healthcare quality, ensuring patient safety, and maintaining uniform national standards, the NHFRA Bill in its current iteration fails to address the systemic bottlenecks in the sector. Instead, it introduces a redundant framework that empowers the proposed agency to inspect, accredit, certify, monitor, investigate, and sanction healthcare facilities—tasks that are already being performed, albeit sometimes with limited resources, by existing boards and councils.
The association warned that if the Bill is enacted, healthcare providers would be subjected to a "regulatory nightmare" involving multiple annual inspections from different agencies, repeated accreditation exercises for the same services, and a proliferation of overlapping regulatory fees. These administrative burdens, HCPAN argues, do not translate into better clinical outcomes but instead divert limited financial resources away from patient care and medical equipment upgrades.
Economic Implications and the Burden on Patients
A significant portion of the association’s concern revolves around the economic impact of the proposed legislation. Nigeria’s healthcare sector is currently grappling with high inflation, the rising cost of pharmaceutical imports, and a brain drain of medical professionals. HCPAN argues that the creation of the NHFRA would necessitate a new stream of revenue for the agency, likely derived from licensing and inspection fees imposed on healthcare providers.
"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 further explained that in the private sector, any increase in operational costs—whether through taxes, levies, or regulatory fees—is inevitably passed down to the consumer. In a country where out-of-pocket expenditure remains the primary means of paying for healthcare, such a move could make essential medical services even more unaffordable for the average Nigerian.
The association pointed out that many private clinics and small-scale laboratories are already struggling to remain viable. Adding the financial weight of a new federal regulator could force many facilities to close or operate sub-optimally, thereby reducing the overall healthcare capacity of the nation.
Jurisdictional Conflicts and Federalism
The HCPAN memorandum also highlighted potential constitutional and jurisdictional conflicts that the NHFRA Bill might trigger. Under the Nigerian Constitution and existing health laws, the regulation and licensing of healthcare facilities have traditionally fallen within the concurrent legislative list, with states playing a dominant role through their respective Ministries of Health and specialized agencies, such as the Health Facility Monitoring and Accreditation Agency (HEFAMAA) in Lagos State.
The proposed federal agency seeks to exercise authority over facilities nationwide, which HCPAN argues could lead to legal disputes between the federal and state governments regarding who has the final say in licensing and enforcement. Such friction, the association claims, would create an environment of uncertainty for investors in the healthcare space, as providers might find themselves caught between conflicting federal and state directives.
A Chronology of Regulatory Advocacy
The current push for the NHFRA Bill comes at a time when the Nigerian government is seeking ways to standardize healthcare quality to meet international benchmarks and curb the proliferation of "quackery" or substandard medical practices. However, the timeline of healthcare reform in Nigeria suggests that the issue has often been one of enforcement rather than a lack of laws.
- 2004: HCPAN was established to unify private providers and engage with the government on policy.
- 2014: The National Health Act was signed into law, providing a legal framework for the regulation, development, and management of the national health system.
- 2022: The National Health Insurance Authority (NHIA) Act was passed, which already includes provisions for quality assurance and facility accreditation for providers under the insurance scheme.
- 2024: The NHFRA Bill is introduced in the National Assembly, seeking to centralize facility regulation under a new autonomous agency.
HCPAN argues that the goals of the 2024 Bill are already largely covered by the National Health Act of 2014. They suggest that the government’s energy should be directed toward the full implementation and funding of existing statutes rather than the creation of new ones.
Proposed Alternatives: Coordination Over Proliferation
Instead of establishing the NHFRA, HCPAN has recommended the development of a National Healthcare Regulatory Coordination Framework. This framework would serve to harmonise the activities of existing institutions, eliminate overlapping responsibilities, and encourage joint inspections among regulators.
The association’s recommendations include:
- Strengthening Existing Councils: Providing better funding and technological tools to the MDCN, PCN, and other councils to enhance their oversight capabilities.
- Digitization of Regulatory Processes: Moving toward an integrated digital platform where providers can upload compliance documents once, accessible by all relevant regulators, thereby reducing the need for multiple physical inspections.
- Joint Inspection Taskforces: Creating inter-agency teams to conduct comprehensive inspections, reducing the frequency of visits and the associated administrative disruption to healthcare delivery.
- Stakeholder Consultation: Engaging in deeper dialogue with private sector practitioners to understand the practical challenges of compliance before passing new laws.
Support from the Pharmaceutical and Allied Sectors
The position of HCPAN has received strong backing from other professional bodies within the health sector. During the Lagos briefing, representatives from the Association of Community Pharmacists of Nigeria (ACPN) stood in solidarity with HCPAN. They argued that the pharmacy profession is already strictly regulated by the Pharmacy Council of Nigeria (PCN) and that the introduction of the NHFRA would create an unnecessary third party in the regulation of pharmaceutical premises.
Stakeholders noted that healthcare is a universal concern, as every citizen is either a patient or a potential patient. They warned that any policy that complicates the operational environment for providers ultimately hurts the patient by increasing wait times, increasing costs, and creating barriers to entry for new, innovative healthcare startups.
Broader Impact and Conclusion
The debate over the NHFRA Bill reflects a broader tension in Nigerian governance between the desire for centralized standards and the practical need for a lean, efficient government. While the proponents of the Bill argue that a central agency is necessary to ensure that a hospital in a rural area meets the same safety standards as one in an urban center, HCPAN maintains that this can be achieved through better coordination of existing state and professional bodies.
As the National Assembly deliberates on the feedback from the public hearing, the healthcare community remains on high alert. HCPAN has reaffirmed its commitment to working with the Federal Ministry of Health and Social Welfare and the National Assembly to find a middle ground. However, the association remains firm that the NHFRA, in its current form, is a step backward for a sector already under immense pressure.
The outcome of this legislative process will have far-reaching implications for the "Ease of Doing Business" in Nigeria’s health sector and, more importantly, for the accessibility and affordability of healthcare for millions of Nigerians. For now, HCPAN continues to advocate for a "reform of the existing" rather than the "creation of the new," urging lawmakers to prioritize the strengthening of Nigeria’s current regulatory architecture.
