By Prof Olayinka Atilola
The recent passage for second reading of the National Health Act (Amendment) Bill, 2026 (SB 759), sponsored by Senator Abdulaziz Musa Yar’Adua, deserves recognition for drawing legislative attention to one of the most distressing challenges in Nigeria’s healthcare system: the denial or delay of emergency medical attention, sometimes with fatal consequences.
As the custodian of the health-sector in the country, the Nigerian Medical Association (NMA) shares the fundamental objective of the proposed legislation.
No Nigerian should lose their life because a hospital insists on a financial deposit before commencing resuscitation, because they are not in possession of a police report to explain their gunshot injury, or because healthcare personnel arbitrarily refuse to attend to someone in a life-threatening condition.
Emergency medical care must be accessible irrespective of a patient’s financial circumstances, social status or the circumstances surrounding the emergency.
Indeed, the tragedy of patients reportedly losing their lives after being denied emergency treatment is a national concern that deserves decisive attention.
The proposed amendment seeks to strengthen Section 20 of the National Health Act, 2014, which already prohibits healthcare providers, health workers and health establishments from refusing emergency medical treatment.
It seeks to move beyond this general prohibition by introducing specific timelines for emergency interventions, mandatory emergency-care standards -including stabilisation measures and immediate commencement of life saving interventions, structured referral procedures, mandatory emergency-care training and certification for healthcare workers involved in emergency services, development of a standardized national emergency care curriculum, and introduction of criminal sanctions ranging from fine to prison terms for health-workers who violates the provisions.
By all standards, therefore, the proposed Bill is grounded in international best-practices in emergency care. It demonstrates an appreciation of the fact that emergency care is not simply about the willingness of a healthcare worker to attend to a patient.
It involves a coordinated sequence of assessment, stabilisation, admission or referral, and access to appropriate transportation and receiving facilities. Furthermore, the proposed Bill attempts to address the longstanding weaknesses in Nigeria’s referral system, where patients are sometimes transferred from one hospital to another without adequate communication, coordination or assurance that the receiving facility can provide the required care.
However, while the intentions of the proposed Bill are genuine and commendable, its provisions, timing and proposed enforcement mechanisms deserve careful scrutiny.
A good law must not only prescribe desirable standards; it must also recognize the practical environment within which those standards are expected to operate.
Nigeria’s healthcare system is burdened by profound structural and operational deficiencies such as inadequate infrastructure, insufficient staffing, shortages of essential medicines and consumables, dysfunctional equipment, unreliable electricity and oxygen supplies, poor ambulance coverage and weak referral networks.
These challenges are not evenly distributed; they are particularly pronounced in many rural and under-served communities.
Consider a hospital emergency department with one doctor attending to several critically ill patients simultaneously, inadequate nursing personnel, no functional oxygen supply, insufficient resuscitation equipment and an ambulance that is either unavailable or non-functional.
How does one meaningfully impose a 15-minute assessment and 30-minute stabilisation obligation on the individual healthcare worker in such circumstances?
What of a patient who requires emergency surgery but arrives at a hospital where the only available operating theatre is occupied, the blood bank has insufficient compatible blood, or the required specialist is unavailable.
Or another patient who requires referral to a tertiary hospital but cannot be transferred because there is no functional ambulance, the receiving hospital has no available bed, or the journey is compromised by insecurity and poor road infrastructure.
These are not hypothetical inconveniences. They reflect the everyday realities confronting healthcare facilities across different parts of the country.
The financing situation compounds the problem. Nigeria continues to depend heavily on out-of-pocket payments for healthcare, while public investment in health remains inadequate.
Many hospitals struggle to procure essential supplies, maintain equipment and sustain basic services. Patients and their families, in turn, frequently struggle to meet the cost of investigations, medicines and procedures. It is therefore important to appreciate that the inability to provide a particular intervention is not necessarily evidence of unwillingness or professional negligence.
The NMA is particularly concerned about the possibility of imposing criminal liability without sufficiently distinguishing between willful professional misconduct and failures arising from institutional or systemic limitations.
There is an important difference between a healthcare worker who deliberately abandons a patient despite having the capacity and resources to provide emergency care, and one who is unable to provide a particular intervention because the necessary equipment, personnel, medicines or infrastructure are unavailable.
There is equally a difference between an avoidable administrative delay and a clinically justified decision informed by the patient’s condition and available resources.
Emergency medicine is a dynamic clinical discipline. Patients present with varying degrees of severity, and clinical decisions must be guided by urgency, clinical judgement and established standards of care. Rigid timelines, if poorly defined or applied without appropriate clinical context, could encourage defensive medical practice, inappropriate interventions and unnecessary referrals rather than better patient outcomes.
Criminal law must address culpable conduct, not merely undesirable outcomes. A patient dying despite appropriate and timely intervention is not necessarily evidence of negligence. Similarly, a delay resulting from circumstances beyond a healthcare worker’s reasonable control should not automatically become a criminal offence.
The Bill’s provision for protecting practitioners who document resource limitations and comply with prescribed referral procedures is therefore important. However, this protection must be strengthened and clearly defined.
The concerns expressed during the Senate debate by Senator Francis Faduyile, himself a medical professional, about criminalising healthcare workers without first addressing inadequate staffing, equipment and funding, deserve serious consideration. His intervention captures the fundamental issue: the obligations imposed by law must be matched by the capacity to fulfil them.
The NMA believes that the proposed legislation provides an opportunity to establish a more comprehensive national emergency-care framework. As such, it would have been more useful, if rather than imposing immediate nationwide compliance, there is a phased implementation process, beginning with designated facilities that meet minimum emergency-care readiness standards and progressively extending to others as the necessary capacity is developed.
This should not become an excuse for indefinite postponement but a realistic implementation strategy with clear milestones. In addition, government and institutional accountability must be explicitly incorporated as it is fundamentally unfair to impose obligations on front-line healthcare workers while leaving the institutions responsible for providing the means of delivering care largely unaccountable.
Federal and State Governments, hospital managements and private healthcare facility owners must have enforceable obligations to provide minimum emergency-care infrastructure, functional equipment, adequate staffing, essential medicines, oxygen, electricity and referral support within the proposed Bill.
Furthermore, criminal sanctions must be more precisely defined. The law should distinguish deliberate refusal, willful abandonment and gross professional negligence from resource-related inability to provide care.
Documented efforts to provide treatment, resource limitations, clinically justified decisions and compliance with referral procedures should attract clearly defined legal protection. Institutional failures should attract institutional sanctions rather than automatically transferring liability to individual practitioners.
Moreover, while the proposed 15-minute and 30-minute benchmarks are useful, the guidelines must however distinguish between triage, clinical assessment and actual commencement of interventions.
Triage must be based on clinical urgency rather than a rigid first-come-first-served arrangement. Clearly defined exceptions should accommodate variations in patient acuity, facility capacity and circumstances beyond the control of healthcare personnel.
Equally important, is for the Bill to address emergency-care financing. The prohibition of financial deposits or advance payments as a condition for initiating life-saving emergency treatment should be unequivocal.
However, hospitals must have a sustainable reimbursement mechanism. We recommend strengthening the National Health Insurance Authority’s emergency-care financing arrangements and establishing or expanding dedicated emergency medical care funding to support participating public and private facilities as a precondition for full implementation of the Bill.
Finally, to avoid legislative overlap, clear responsibilities should be carved for professional regulatory bodies, such as the Medical and Dental Council of Nigeria, in the the investigation of alleged violations under the proposed Bill. A law that saves lives must also protect those who save lives
The NMA is willing to engage constructively with the Senate Committee and other stakeholders to ensure that the final legislation achieves its intended purpose. Ultimately, the objective must be to build a system in which patients are not abandoned, healthcare workers are not unfairly criminalized, and government is held accountable for providing the conditions necessary for effective emergency care.
Prof Olayinka Atilola is a medical practitioner and the National Publicity Secretary of the Nigerian Medical Association
