ILO Social Protection Floor NHIS AndECA

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ILO's Social Protection Floor (SPF), the Employees Compensation Act (ECA) and the

National Health Insurance Scheme (NHIS) Act : A Comparative Analysis1

By

Femi Aborisade

Labour Consultant and Attorney-At-Law

[email protected]

Introduction

This paper is a doctrinal and comparative paper in the sense that it sets out the basic provisionsof the ILO Social Protection Floor and attempts a comparison with the National Health Insurance

Scheme (NHIS) Act and the Employees Compensation Act (ECA).

The paper is thus structured as follows:

1. Analysis of key provisions of the ILO Social Protection Floor (SPF).

2. Analysis of key provisions of the NHIS Act

3. General Comparison of SPF with NHIS Act

4. Relationship between ECA and ILOs SPF

5. The Role of Trade Unions

6. Conclusion

ANALYSIS OF ILOs SPF

Background to SPF

The Social Protection Floor (SPF) was initiated by the International Labour Office and the World

Health Organization, involving 17 collaborating agencies, including the United Nations (UN),

NGOs and international financial institutions. The United Nations System Chief ExecutivesBoard for Coordination (UNCEB) adopted the Social Protection Floor Initiative in April 2009. In

2011, the International Labour Organiation at its 100 th Session adopted [certain] Resolution and

Conclusions concerning the recurrent discussion on social protection. The Conference, amongother conclusions, acknowledged the need for a Recommendation complementing the existing

standards that would provide flexible but meaningful guidance to member States in building

1Being paper delivered at a Workshop organized by the Food, Beverage and Tobacco Senior Staff Association in

collaboration with Friedrich Ebert Foundation on the theme "Social Protection and the Decent Work Agenda in the

Food. Beverage and Tobacco Industry: Issues Arising" on 19th- 20th April, 2013 at Grand Inn and Suites, IJebu-

Ode, Ogun State

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Social Protection Floors within comprehensive social security systems tailored to national

circumstances and levels of development. Consequently, on 30 May 2012, the General

Conference of the International Labour Organization, at its 101st Session, adoptedRecommendation 202 concerning National Floors of Social Protection. This paper is based on

the articulation of SPF as contained in the ILO Recommendation 202.

The Goal of SPF

The International Labour Conference at its 100th Session noted that the SPF is not just a human

right but that closing coverage gaps in social security coverage is of highest priority for equitableeconomic growth, social cohesion and Decent Work for all women and men Thus, the ILO

Recommendation 202, in its Preamble, declares social security a right. The key goal of the SPF

is to prevent and reduce poverty, inequality, social exclusion and social insecurity

Paragraph 2 of the Recommendation goes further to define SPF as nationally defined sets of

basic social security guarantees which secure protection aimed at preventing or alleviating

poverty, vulnerability and social exclusion

The United Nations Chief Executives Board (CEB) has also defined social protection floor as anintegrated set of social policies designed to guarantee income security and access to socialservices for all, paying particular attention to vulnerable groups, and protecting and

empowering people across the life cycle.

The central target of SPF therefore is support for disadvantaged groups and people with

special needs (Paragraph 16, ILO Recommendation on SPF) through comprehensive national

social security systems.

The Preamble also makes it clear that the Social Protection Floor is based on the rights

contained in earlier international instruments, particularly:

the Universal Declaration of Human Rights (UDHR) (in particular, Articles 22 and25),

the International Covenant on Economic, Social and Cultural Rights (ICESCR) (in

particular, Articles 9, 11 and 12),

ILO social security standards, in particular the:

Social Security (Minimum Standards) Convention, 1952 (No. 102),

the Income Security Recommendation, 1944 (No. 67), and

the Medical Care Recommendation, 1944 (No. 69).

Who has primary responsibility for SPF?

Paragraph 3 of the ILO Recommendation provides an answer to this question: it states that the

State has primary responsibility, as follows:

3. Recognizing the overall and primary responsibility of the State in giving effect to this

Recommendation.

Minimum scope of SPF

Paragraph 5 (a) to (d) of the ILO Recommendation on SPFs requires member countries to set a

Social Protection Floor that provides four (4) categories of minimum social security guarantees:

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Provision of Health care (on a universal basis), which includes maternity care, that

meets the criteria of availability, accessibility, acceptability and quality ;

Income security for children, which guarantees access to nutrition, education, care and

any other necessary goods and services;

National Minimum income security forpersons in active age who are unable to earn

sufficient income in cases of:

o

o sickness (sick benefits);

o

o Unemployment (unemployment benefits)

o

o Maternity (maternity benefits)

o

o Disability (Disability benefits), and

National Minimum income security for olderpersons (old age pensions, regardless of

prior employment status or sector of employment, if previously employed)

Paragraph 9(2) complements paragraph 5 by providing that:

(2) Benefits may include child and family benefits, sickness and health-care benefits,

maternity benefits, disability benefits, old-age benefits, survivors benefits,

unemployment benefits and employment guarantees, and employment injury benefits as

well as any other social benefits in cash or in kind.

Schemes

Paragraph 9(3) identifies the Schemes that may be established to provide the benefits. Theyinclude:

universal benefit schemes,

social insurance schemes,

social assistance schemes,

negative income tax schemes,

public employment schemes, and

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employment support schemes

Minimum Coverage of SPF

Paragraph 6 of the Recommendation provides for universal coverage, stating that Membersshould provide the basic social security guarantees referred to in this Recommendation to at

least all residents and children

Sources of funding benefits

In line with Paragraph 3, which places primary responsibility on the State to implement the SPF,

paragraph 12 also provides that national social protection floors should be financed by:

national resources, and

International support, where national capacity is inadequate

Paragraphs 10 and 11 identify ways to facilitate mobilization of resources for SPF nationally:

Contributory schemes, individually or collectively, taking into account the contributory

capacities of different population groups. (Paragraph 11)

enforcement of tax obligations (Paragraph 11)

reprioritizing expenditure (Paragraph 11)

broadening national revenue base (Paragraph 11)

Implementing measures to prevent fraud, tax evasion and non-payment of

contributions.

promoting productive economic activity and formal employment through policies

such as:

o

o government credit provisions (paragraph 10)

o

o labour inspection (paragraph 10)

o

o tax incentives (paragraph 10) and

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policies that promote:

o

o education (paragraph 10)

o

o vocational training (paragraph 10)

o

o productive skills and employability (paragraph 10).

Guiding Principles2

The ILO Recommendation on SPF prescribes the following principles to guide the

implementation of the programme:

Member nations are required to apply the following principles:

(a) universality of protection, based on social solidarity;

(b) entitlement to benefits prescribed by national law;

(c) adequacy and predictability of benefits;(d) non-discrimination, gender equality and responsiveness to special needs;

(e) social inclusion, including of persons in the informal economy;

(f) respect for the rights and dignity of people covered by the social security guarantees;(g) progressive realization, including by setting targets and time frames;

(h) solidarity in financing while seeking to achieve an optimal balance between the

responsibilities and interests among those who finance and benefit from social security schemes;(i) consideration of diversity of methods and approaches, including of financing mechanisms

and delivery systems;

(j) transparent, accountable and sound financial management and administration;(k) financial, fiscal and economic sustainability with due regard to social justice and equity;

(l) coherence with social, economic and employment policies;(m) coherence across institutions responsible for delivery of social protection;

(n) high-quality public services that enhance the delivery of social security systems;(o) efficiency and accessibility of complaint and appeal procedures;

(p) regular monitoring of implementation, and periodic evaluation;

(q) full respect for collective bargaining and freedom of association for all workers; and(r) tripartite participation with representative organizations of employers and workers, as

well as consultation with other relevant and representative organizations of persons concerned.

(paragraph 3).

Establishment of Legal framework

2 In this subsection, the statements in bold formats from a-r are authors addition.

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The ILO requires that the basic social security guarantees should be established by law

(paragraph 7) based on national consultations through effective social dialogue and social

participation (paragraph 13).

ANALYSIS OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) ACT

Establishment

The NHIS was established by the National Health Insurance Scheme Act, 1999 but it fomally

took off in 2005.

Key Objective

The Long Title to the Act states that the key objective is to [ensure] access to good health care

services to every Nigerian and protecting Nigerian families from financial hardship of huge

medical bills.

The Condition for entitlement to healthcare services

Payment of rates of contribution as may be prescribed 3 from time to time by the Schemes

Governing Council is the condition for accessing health services provided by the Scheme (seesections 16 and 17, NHIS Act). In other words, beneficiaries under the Scheme must have the

financial ability to pay the prescribed rate of contribution. The poor who lack the financial

capacity are thus clearly excluded. This is in spite of the fact that the NHIS is funded by grants

from the Federal, State and Local Governments, as well as international or donor agencies (S. 11,NHIS Act).

Categories of Contributors

The NHIS Act provides for two categories of contributors (Ss. 16 and 17):

employee contributor, and

voluntary contributor.

An employer (whether in the private or public sector) who has a minimum of ten employees (S.16(1), is required to apply to register itself and its employees with the Scheme. The employer is

empowered to deduct the contribution by the registered employees from their salaries and payboth its contribution and the employees contribution into the account of designated HealthMaintenance Organizations (S. 17(1) and (2).

3 In reality, the employer pays 10 per cent of the employees basic salary while the employee contributes five per

cent of his/her basic salary. A policy usually covers a couple and four children under the age of 18

(http://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/).

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The voluntary contributor is a person other than an employee who opts to register with the

Scheme and pays the prescribed rate of contribution (S. 17(3).

FUNDAMENTAL WEAKNESSES OF THE NHIS

1. ACCESS TO HEALTH SERVICES IS BASED ON ABILITY TO PAY; NOT

BASED ON HEALTH AS A RIGHT

Considering the fact that access to health services under the NHIS is based on ability to pay the

prescribed rate of contribution, and not on account of need for health services, it can be

concluded that the NHIS is not founded on the recognition that access to health is a right. The

ability to pay as a condition to be entitled to healthcare services is therefore an

exclusionary policy. Employees working for an employer with less than ten employees are

excluded, employees who do not earn enough as to be able to afford registering with the Scheme

are excluded, the unemployed, poor farmers, the informal sector, children and the aged are

equally excluded. From findings by journalists, the NHIS currently covers only between 4m and5m contributors. This means that the Scheme covers only about 3% and excludes the remaining

97% of the population, based on 170million estimated population of Nigeria.

The exclusionary policy contained in the NHIS Act is contrary to the provisions of the ILO

Recommendation on SPF and other international instruments, including the African Charter. TheAfrican Charter, just as the ICESCR and the UDHR, earlier referred to, provides in Article 16

that:

Article 16(1):

Every individual shall have the right to enjoy the best attainable state of physical and

mental health.

Article 16(2): State parties to the Charter are:

to take the necessary measures to protect the health of their people and to ensure that they

receive medical attention when they are sick.

That overwhelming majority of Nigerians are excluded from the NHIS is shown by findings bynewspaper journalists who variously established that since the Scheme officially took off in

September 2005, only between 4 and 5m4 contributors/beneficiaries have subscribed. So, almost

all Nigerians, or around 170million people and at least 93% of the population are excluded fromthe NHIS.

2. NHIS IS SET UP TO PROVIDE LIMITED AND DEFINED RANGE OF HEALTH

SERVICES

4http://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-

nigerian-masses,http://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/,

www.ncbi.nlm.nih.gov/pubmed/23064174, http://jointlearningnetwork.org/content/national-health-insurance-system

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http://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/http://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/http://www.ncbi.nlm.nih.gov/pubmed/23064174http://jointlearningnetwork.org/content/national-health-insurance-systemhttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/http://www.ncbi.nlm.nih.gov/pubmed/23064174http://jointlearningnetwork.org/content/national-health-insurance-system


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The scope of health services provided to contributors by the NHIS is too limited. The

NHIS is not set up to provide comprehensive health care based on the health condition ofthe contributors. For example, as Section 18 shows, health care providers are to

provide:

defined elements of curative care (S. 18(a);

prescribed drugs and diagonistic tests (S. 18(b), meaning they are to provide

predetermined range of drugs and tests;

maternity care for up to four live births for every insured person (S. 18(c),

meaning children born after the fourth child are not entitled to health care servicesunder the Act;

consultation with defined range of specialists (S. 18(e);

eye examination and care, excluding test and the actual provision of spectacles

(S. 18(g); and

a range of prosthesis and dental care as defined (S. 18(h).

The defined and limited range of health care services provided under the NHIS run contrary to

Article 12 of the International Covenant on Economic, Social and Cultural Rights

(ICESCR, 1966), which provides that:

1. The States parties to the present Covenant recognize the right of everyone to the

enjoyment of the highest attainable standard of physical and mental health.2. The steps to be taken by the States parties to achieve the full realization of this

right shall include those necessary for:

(a) The provision for the reduction of the still birth rate and of infant mortalityand for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational andother diseases;

(d) The creation of conditions which would assure to all medical services and

medical attention in the event of sickness.

3. NHIS AS A SOURCE OF WASTE AND AVOIDABLE EXPENDITURE

The NHIS has a Governing Council, other full time Staff, national headquarters, zonal offices,zonal officers, registered Health Maintenance Organizations (HMOs), registered Health Care

Providers, and so on5. The central purpose of the NHIS structure is geared towards enlisting

health care providers (that is, government and private health care practitioners, hospitals or

maternity centres) to provide health services to insured persons or contributors. The GoverningCouncil and the army of its full staff are not recognized to enter into contracts with health care

providers. Contracting with health care providers for the purpose of rendering health careservices under the Act is assigned to Health Maintenance Organizations (HMOs) (S. 20(e).

5 Currently, findings by journalists reveal that 61 Health Maintenance Organisations (HMOs) have been accredited

and registered by NHIS in addition to about 6,000 primary care providers, 1,000 ancillary providers, and over 600

secondary and tertiary providers (See notation number 2 above).

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The Health Maintenance Organizations (HMO) is defined as an organization registered by the

Governing Council to utilize its administration to provide health care services through approvedhealth care centres (S. 49). Among others, a health maintenance organization collects

contributions from eligible contributors, pays capitation fees for services rendered by health

care providers (S. 20), and invest and mange the funds accruing to it from contributions receivedpursuant to the Act (S. 19(2).

It is my contention that the NHIS structure and modus operandi constitute a drain on public

resources. It is similar to what operates in the US where the health system consists of largely

private hospitals and other health facilities funded by private health insurance. However, the US

system provides state insurance (medicare and mediaid) for the poor and elderly. On the basis of

reliance on private hospitals (which the Nigerian NHIS Act calls health care providers), the US

has the most expensive health care system in the world. But its health outcomes, for example,

life expectancy and child mortality rates are almost the lowest of the developed countries. Large

numbers of Americans (nearly 20% of the population) are not insured and have to pay their ownfees if they fall ill.

The NHIS could exist as a unit of the Ministry of Health and staffed by public employees to

carry out administrative functions, within a context where the State/government takes primaryresponsibility for health care, as a right. Even in the UK, the principle that health services should

be available to all at the point of delivery is accepted across the political spectrum. The new

leader of the Conservatives has recently said that they now accept that principle.

The capacity of public hospitals should be enhanced to render health services rather than relying

primarily on private health care providers. In this way, more doctors and other medical staff

would be required and employed. In that context, the NHIS would not require a GoverningCouncil whose Chairman is appointed from the private sector (S. 2(3), NHIS Act) and earning

salaries and allowances that could employ several health personnel. Contracting Health

Maintenance Organisations to contract with health care providers would also be absolutelyunnecessary. But the NHIS, as currently structured, is programmed to attain the neoliberal policy

of the State passing responsibility for health care provisioning to the private sector. That is why

one of the listed objectives of the NHIS is to improve and harness private sector participation inthe provision of health care services (S. 5(g), NHIS Act).

4. NHIS ACT DOES NOT REFLECT THE GUIDING PRINCIPLES CONTAINED

IN THE ILO SPF

Based on the three identified weaknesses above, it can be deduced that the NHIS Act is not

governed by the guiding principles contained in the ILOs SPF, which is itself based on existinginternational instruments.

It is clear from the foregoing that the following guiding principles stipulated in Paragraph 3 ofthe ILO Recommendation 202, are not observed in the NHIS Act:

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universality of protection (Paragraph 3(a);

adequacy and predictability of benefits (Paragraph 3(c);

social inclusion, including of persons in the informal economy (Paragraph 3(e);

tripartite participation with representative organizations of employers and workers

(Paragraph 3(r) at least, it formally excludes representation of the TUC in the

Governing Council.

RELATIONSHIP BETWEEN EMPLOYEES COMPENSATION ACT (ECA) 2010 AND

ILOS SPF

The Employees Compensation Act, ECA, 2010 can be related to ILOs SPF to the extent that itmay be presumed to represent an attempt to fulfill the right to health as far as industrial injuries

are concerned. However, it is necessary to bear in mind that ECA is relevant only tocompensations for any death, injury, disease or disability arising out of or in the course of

employment.

By virtue of S. 26(1) of ECA,

In addition to the other compensation provided by this Act, the Board may provide for the

injured employee any medical, surgical, hospital, nursing and other care or treatment,

transport, medicines, crutches and apparatus, including artificial members, that it mayconsider reasonably necessary at the time of the injury and thereafter during the

disability, to cure and relieve from the effects of the injury or alleviate those effects

As indicated above, apart from healthcare and disability support, the ECA, in its Part IV

(sections 17 to 30) recognises the following three broad categories or five specific categories of

incapacity:

1. Fatal cases death, resulting from injury or disease

2. Permanent Disability

a. Permanent total disability

b. Permanent partial disability or disfigurement

3. Temporary Disability

a. Temporary total disability

b. Temporary partial disability

What is considered to be of particular relevance here is to determine whether the rates of

compensation are adequate to ensure the standard of health as perceived in international

instruments.

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We may measure adequacy of compensation based on the categories of scale of compensation

stated above:

1. Fatal cases, i. e. Death

2. Permanent Total Disability

3. Permanent Partial disability -

4. Temporary Total Disability -

5. Temporary Partial Disability -

In order to have a sense of the inadequacy or otherwise of the compensation rates under the Act,

let us assume a deceased or injured worker on the minimum wage of N18,000 per month, for

each of the above five categories of disability.

Measuring Adequacy of Compensation in the Event of Death of the Injured Employee (S.

19 and S. 17(1)(a)(i) subject to S. 17(1)(c) as regards a child-dependant)

The compensation payable here varies between 90 and 30 per cent of deceased employeesearnings, for the lifetime of the beneficiary, depending on the number and composition of thedependants. For an employee on the minimum wage, this translates to between N16, 200 and

N5, 400. The adequacy or inadequacy of compensation in this category can be imagined.

It should be noted that the dependants are denied the benefit of likely increased wages of theemployee based on improvement in performance, increased number of years of practical

experience, promotion based on training and educational development, and so on.

Also, whereas children are dependent on their parents, even after their studies until they secure

gainful jobs, S. 17(1)(c) of the Act provides that monthly payments to eligible children underthis Act shall be made to children up to the age of 21 or until they complete undergraduatestudies, whichever comes first. In this era of widespread unemployment where what is certain is

the unlikelihood of securing jobs after undergraduate studies, S. 17 (1) (c) of the Act is a harsh

provision, which deprives children of deceased employees of compensation.

Measuring Adequacy of Compensation Based on Permanent Total Disability (Ss. 21(1) and

23), ECA).

The statutory provision under this subhead isperiodic payment of 90 per cent of the employees

earnings, until he attains 55 years of age, or if he is already 55 or more, then, for 2 years after the

date of the injury.

Thus a 54-year old employee on N18, 000 per month will earn 90% of N18,000 or N16,200per month for only one year for a total disability that is permanent.

Measuring Adequacy of Compensation Based on Permanent Partial Disability (S. 22(2),

ECA)

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For a disability that is considered to be Permanent Partial Disability, the compensation is

periodic payment of 90 per cent of an estimate of the loss of remuneration, which results from

the disability or impairment,until the employee attains 55 years of age, or if he is already 55 ormore, then, for 2 years after the date of the injury. For the employee on the minimum wage scale,

for whom the estimate of the loss of remuneration is considered to be 50%, his compensation

will be 90% of N9,000, which gives a take home pay of N8,100 per month for one year, untilhe attains 55 years of age.

In the case of Temporary Disability, whether Total (S. 24(1), ECA) or Partial ( S. 25(1),

which lasts for not more than 12 months, only a Lump sum payment (that is, a once and for

all payment) based on the degree of disability in accordance with the Second Schedule to the

Act will be paid. Thus, in the case of loss of limb or Loss of both hands or of all fingers and

thumbs for which the Second Schedule to the Act provides for 100% degree of disability, themaximum lump sum compensation, which an employee on the National Minimum Wage is

entitled to is N18,000.

The big question is: are these rates of compensation for industrial hazards adequate to

maintain health as defined by WHO and UDHR? The evidence provided above suggests thatthis is clearly not the case. The Employees Compensation Act, 2010 does not provide foradequate compensation in line with international standards and norms, which the Government of

Nigeria has signed up to.

THE ROLE OF TRADE UNIONS

The trade unions have a responsibility to accept and campaign nationally for it to become asocietal norm that the State has primary obligation to:

Accept that health care is a fundamental right which is supplied free to all citizens whenit is needed.

Accept primary responsibility for health services to all its citizens.

o The basic issue which NHIS raises is: who should pay the cost of health care?

Should health care be accessed only by those who can afford to pay or shouldgovernments provide for all, particularly the poor?

o

o The fact that all economies are subject to economic booms and recessions is a

strong reason why government should be made responsible for health care. In

recession, unemployment increases as well as diseases of poverty and stress.

Thus, many people need health services most when they can least afford to

pay for them or when they are no longer insured through their work.

:

Health care services should be paid for from general taxation, rather than relying on

health insurance schemes.

o

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o There tends to be much less direct control of health expenditure where health

insurance schemes are used, which explains why countries such as the US and

France have so much trouble controlling their health costs. For example, the US

spends more on administering its health insurance system per person than the totalhealth-spend per person in all but the most developed 35 countries.

o

o Also, health insurance emphasizes curing of illness rather than prevention,

whereas prevention is much more efficient especially in Africa where diseases

such as malaria, diarrhea, HIV/AIDS etc could be avoided much more cheaply

than the cost of their treatment.

Assume primary responsibility for implementing ILOs SPF without shifting

responsibility to the private sector. The private sector should contribute through general

corporation tax. Schemes other than the system by which the State accepts primaryresponsibility for health care to all the citizens have proved to be inefficient and costly to

administer.

Amend the NHIS Act, particularly to remove all provisions, which make it exclusionary.The effect of the exclusionary character of the NHIS is that when families belonging to

the excluded 93% of the population fall sick, they have to beg, steal or borrow to access

health care. The result is unnecessary death, disease, pain and suffering. Concerns andworries from attempting to repay the debt incurred in accessing health care could also

result in long term poverty and other stress-related health conditions.

Ratify and implement, as indicated in Paragraph 18 of the ILO Recommendation 202, the

Social Security (Minimum Standards) Convention, 1952 (No. 102), other ILO social

security Conventions and Recommendations setting out more advanced standards, as wellas other relevant UN instruments, such as the ICESCR.

Accept and campaign that the right to health is not just the absence of diseases or

infirmity but a state of complete physical, mental and social wellbeing (Preamble tothe Constitution of the World Health Organization, WHO).

For the avoidance of any doubt, Article 25(1) of the Universal Declaration of Human Rights(UDHR, 1948) has expatiated and clarified WHOs definition of the right to health:

Everyone has the right to a standard of living adequate for the health and well-being of

himself and his family, including food, clothing, housing and medical care and necessary

social services, and the right to security in the event of unemployment, sickness,

disability, widowhood, old age or other lack of livelihood in circumstances beyond hiscontrol

The understanding in both the WHO definition of health and Article 25(1) of the UDHR

places a responsibility on civil society, including the trade union movement, to demand that

governments should implement other socio-economic rights as part and parcel of the right

to life (guaranteed under S. 33 of the 1999 Constitution) and the right to health, which the

NHIS purportedly sets out to fulfill.

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CONCLUSION

We live in an age which is characterized by many successful attempts to hijack the State fromserving the interests of the poor and marginalized to serving only the interests of the wealthy,

exploiters and looters of the public patrimony. The age when UDHR was declared is graduallygiving way to the age when aggressive efforts are being made to take away these rights, not only

at national levels but also at international levels. Advocacy for those rights and the primary roleof the State to implement socio-economic rights should be combined with practical protests,

rallies and strikes for their full realization.

Every human right has a relationship to the right to life. To that extent, every right should be:

o Universal,

o Inalienable,

o Equal,

o Indivisible,

o Interdependent and

o Interrelated.

Similarly, under international human rights law, membership of the United Nations isaccompanied by certain obligations on the part of the ratifying State. Every State has the

obligation to respect, protect, and fulfill human rights. The obligation to respect means that the

state must not interfere with the enjoyment of given rights; the obligation to protect implies thatthe State restrains third parties who may infringe on the rights of others while the obligation to

fulfill means that the state takes positive measures to promote enjoyment of rights. These

obligations of the state under international law would not be observed unless the working masses

take practical action to protect and advance their rights.

The Nigerian labour movement should learn from its South African counterpart where civil

organizations are formed by trade unions to carry out massive protests for provision of housing,

against forceful eviction, lack of access to water and electricity, including active campaigns

against disconnection of non-payers.

REFERENCES

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Statutes Cited

Employees Compensation Act, 2010

National Health Insurance Scheme Act, 1999.

Websites

http://www.ilo.org/dyn/normlex/en/f?

p=1000:12100:0::NO::P12100_INSTRUMENT_ID:3065524 (R202 - Social Protection Floors

Recommendation, 2012 (No. 202)

http://www.ilo.org/global/publications/ilo-bookstore/order-

online/books/WCMS_146616/lang--en/index.htm (Extending social security to all A guide

through challenges and options)

http://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdf(Social protection

floor for a fair and inclusive globalization)

http://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdf(UNICEF-ILO

Social Protection Floor (SPF) Costing Tool Explanatory Note)

(http://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/).

http://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masses

www.ncbi.nlm.nih.gov/pubmed/23064174

http://jointlearningnetwork.org/content/national-health-insurance-system

http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita

http://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States

http://www.nejm.org/doi/full/10.1056/NEJMsa022033#t=articleResults

http://www.businessdayonline.com/NG/index.php/analysis/commentary/50441-nigerias-health-

finance-gap

http://www.businessdayonline.com/NG/index.php/analysis/commentary/50695-reforming-the-national-health-insurance-scheme-nhis

http://jointlearningnetwork.org/content/national-health-insurance-system

15 | P a g e
http://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:3065524http://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:3065524http://www.ilo.org/global/publications/ilo-bookstore/order-online/books/WCMS_146616/lang--en/index.htmhttp://www.ilo.org/global/publications/ilo-bookstore/order-online/books/WCMS_146616/lang--en/index.htmhttp://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdfhttp://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdfhttp://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/http://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.ncbi.nlm.nih.gov/pubmed/23064174http://jointlearningnetwork.org/content/national-health-insurance-systemhttp://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capitahttp://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_Stateshttp://www.nejm.org/doi/full/10.1056/NEJMsa022033#t=articleResultshttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50441-nigerias-health-finance-gaphttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50441-nigerias-health-finance-gaphttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50695-reforming-the-national-health-insurance-scheme-nhishttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50695-reforming-the-national-health-insurance-scheme-nhishttp://jointlearningnetwork.org/content/national-health-insurance-systemhttp://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:3065524http://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:3065524http://www.ilo.org/global/publications/ilo-bookstore/order-online/books/WCMS_146616/lang--en/index.htmhttp://www.ilo.org/global/publications/ilo-bookstore/order-online/books/WCMS_146616/lang--en/index.htmhttp://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdfhttp://www.ilo.org/public/english/protection/secsoc/downloads/bachelet.pdfhttp://nationalmirroronline.net/new/health-insurance-scheme-still-in-a-shambles/http://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.tribune.com.ng/index.php/features/31498-national-health-insurance-scheme-of-what-benefit-to-nigerian-masseshttp://www.ncbi.nlm.nih.gov/pubmed/23064174http://jointlearningnetwork.org/content/national-health-insurance-systemhttp://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capitahttp://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_Stateshttp://www.nejm.org/doi/full/10.1056/NEJMsa022033#t=articleResultshttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50441-nigerias-health-finance-gaphttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50441-nigerias-health-finance-gaphttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50695-reforming-the-national-health-insurance-scheme-nhishttp://www.businessdayonline.com/NG/index.php/analysis/commentary/50695-reforming-the-national-health-insurance-scheme-nhishttp://jointlearningnetwork.org/content/national-health-insurance-system

Documents

ILO Social Protection Floor NHIS AndECA