REVEALED: THE NEW NATIONAL HEALTH ACT 2014 BURIES MEDICAL LABORATORY SCIENCE UNDER THE PATHOLOGISTS

The new National Health Act of Nigeria 2014 has smashed to pieces any iota of hope for the medical laboratory science profession to exist as an independent profession that is not subservient to the medical practitioners in Nigeria. This is because the new National Health Act 2014, has placed the authority and powers of the medical laboratory scientists to touch or use human specimens for analysis and production of biologicals directly under the approval and supervision of the medical practitioners. 

In 2015, the National Industrial Court of Nigeria declared the medical laboratory science profession as an independent profession from any other professions. This decision came a year after the enactment of the new National Health Act 2014. It then beggars questions what the medical litigants and their legal counsel canvassed at the National Industrial Court of Nigeria that led the Court to make that declaration in view of the clear provisions of the new National Health Act enacted a year before the Court decision. 

The basis for the decision of the National Industrial Court of Nigeria, stating that the medical laboratory science profession was an independent profession which had in effect, essentially replaced the field of Pathology, was that, to the presiding judge, the Medical Laboratory Science Council of Nigeria Act No 11 of 2003, came into conflict with the Medical and Dental Council Act of Nigeria 1988, with the newer Act of 2003 impliedly repealing the provisions of the conflicting relevant provisions of the older Act of 1988. 

The National Health Act 2014, which is the newest Act of the National Assembly of Nigeria in relation to health matters, has destroyed all that gains from the decisions of the National Industrial Court of Nigeria in favour of the laboratory scientists. A befitting dissection of this ephemeral victory at the National Industrial Court of Nigeria by the medical laboratory scientists is hereby below pieced up and pieced together. 

The Medical Laboratory Science profession was created and mandated to be:
“Medical Laboratory Science”- "Means the practice involving the analysis of human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment for the purpose of MEDICAL LABORATORY diagnosis, treatment and research.

This mandate, it appears, and in fact as has now been clearly provided, has been limited and restricted to a complete supervision and control of the medical and dental practitioners, by the National Health Act of Nigeria 2014. The debate now is no more if there is a conflict between the medical laboratory science profession and pathology. The debate is no longer if medical laboratory science profession has repealed in part and replaced pathology. No. 

The debate now is whether in fact there is any profession called medical laboratory science without the sanction of the Medical Profession. The debate, in fact, is whether a medical laboratory scientist can ever analyze a human sample without authorization and supervision of the medical practitioners. The clear provisions of the new National Health Act 2014 has specifically attached the medical laboratory science profession to the apron strings of the medical and dental practitioners in Nigeria. The relevant sections of the laws are hereby laid down for construction. 

Section 29 of the Medical Laboratory Science Council of Nigeria Act states:
“Medical Laboratory Science”- "Means the practice involving the analysis of human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment"

Section 52 of the National Health Act 2014 states:
(1) Only a registered medical practitioner or dentist may remove any tissue from a living person, use tissue so removed for any of the purposes stated in this Act or transplant tissue so removed into another living person
(2) Only a registered medical practitioner or dentist , or a person acting under the supervision or on the instructions of a medical practitioner or dentist , may administer blood or a blood product, or prescribe blood or a blood product for, a living person

Section 64 of the same Act states:
"tissue" means human tissue, and includes flesh, bone, a gland, an organ, skin, bone marrow or body fluid, but excludes blood or a gamete

Section 49 (1) of the Act states: 
Subject to the provision of section 52 of this Act, a person shall use tissue removed or blood or a blood product withdrawn from a living person only for such medical or dental purposes as may be prescribed.

Section 48(1) of the National Health Act states further: 
Subject to the provision of section 53, a person shall not remove tissue, blood or blood product from the body of another living person exerpt 
(a) with the informed consent of the person from whom the tissue, blood or blood product is removed granted in the prescribed manner 
(b) that the consent clause may be waived for MEDICAL INVESTIGATIONS and TREATMENT in emergency cases; and 
(c) in accordance with prescribed protocols by the appropriate authority.

Section 59 then goes on to state: 
The Minister , in consultation with the National Council, may make regulations with regard to any other matter which is reasonably necessary or expedient to prescribe in the implementation of this Act

The Long Title of the National Health Act declares:
An Act To Provide A Framework For The Regulation , Development And Management Of A National Health System And Set Standards For Rendering Health Services In The Federation; And For Related Matters

Section 1 (1) of the Act goes on to state:
There is established for the Federation the National Health System, which shall define and provide a framework for standards and regulation of health services, without prejudice to extant professional regulatory laws

Section 64, which is the Interpretation Section of the National Health Act states:
"National Health System" means the system within the Federal Republic of Nigeria, whether in the public or private sector, concerned with the financing, provision or delivery and regulation of health services.

The laid sections are essentially self explanatory. Medical investigations and treatment as used in section 48(1)(c) of the National Health Act, has to be subtly and meticulously contrasted with the use of medical laboratory diagnosis, treatment and research, as used in section 29 of the Medical Laboratory Science Council of Nigeria Act. 

In conclusion, the National Health Act subsumed every other professional regulatory law, by preservation and superimposition. The Act saved all the regulatory laws, while at the same time providing framework and conditions for their operability. 

The National Health Act preserved the definition and function of Medical Laboratory Science to analyze human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment on one hand; while at the same time subjected the collection and use of such human tissues, body fluids and excretions for any national health purpose, to the supervision, direction and approval of the medical practitioners in section 52 of the National Health Act 2014.

The import of section 52 of the National Health Act 2014 is that the collection, use, supervision and direction of use of human samples in the health sector, from a living person, are now exclusively dispatched to the sole prerogative of the medical practitioners. This simply means that medical laboratory scientists cannot analyze human samples without the collection by medical and dental practitioners, the approval and sanction of the use in the health sector by the medical and dental practitioners. The traditional medical and alternative practitioners are also barred by this provision from collection or use of human samples in the health sector without the sanction of the medical and dental practitioners. 

Medical and Dental practitioners are the only categories of professionals empowered by law in Nigeria to collect, use or direct the use of tissues and body fluids from a living person in Nigeria. Also, the combined effects of section 48 and 52 are that only medical and dental practitioners can undertake medical investigations and treatment of living persons. Only medical and dental practitioners can prescribe the use of blood or a blood product in Nigeria. The purported areas of Medical laboratory Science profession, namely ; the medical microbiology, clinical chemistry, chemical pathology, haematology, blood transfusion science, virology, histopathology, histochemistry, immunology, cytogenetic, exfoliative cytology parasitology, forensic science, molecular biology, laboratory management; or any other related subject as may be approved by the Council; are therefore mere obvious decorations of a drained and exanguinated profession that are only transfused and revitalized by the sanctions of the medical and dental practitioners. 

The curious issue now is whether, in the first place, the medical laboratory science profession is among those professions the National Health Act seeks to moderate, harmonize and integrate. Is medical laboratory science profession a profession in the health services delivery system!  I have repeatedly contended in other fora and articles that the profession of medical laboratory science is not a hospital based profession. It is not a member of the National Health System as established in the National Health Act of 2014. It is not a hospital based establishment. Rather, it is a profession charged with the responsibility to produce medical equipment and reagents. 

This argument has been buttressed repeatedly by the clear provisions in the National Health Act that only medical and dental practitioners can carry out pathological laboratory investigations in the National Health System of Nigeria when the use of human tissues from living persons is involved. That means that the only leeway available for the medical laboratory scientists to use human tissues for medical laboratory science is if their professional functions are not included in the purposes created by the National Health Act, which purposes are only performed by medical and dental practitioners when it touches on the use of human tissues. 

Therefore, as stated in section 52 (1) of the National Health Act 2014 states:
Only a registered medical practitioner or dentist 
(a) may remove any tissue from a living person
(b) use tissue so removed for any of the purposes stated in this Act or 
(c) transplant tissue so removed into another living person
Thus, if the statutory functions of the medical laboratory scientists are included in the second limb of section 52(1) of the National Health Act 2014, then the profession of medical laboratory science has been abolished by the National Health Act by this provision of section 52(1). The only possible conclusion is that medical laboratory science profession is not included in the second limb of section 52(1), it is not a hospital based profession, and it is not envisaged or factored into, by the National Health Act, which Act is also far later in time, as an integral part of the National Health System of Nigeria. 


The activism and exploits of the medical laboratory science professional group to emerge as an independent profession that is not under the apron strings of the medical and dental profession has thus suffered mortal staccato blows and is hereby given a staggering and shattering cudgel by the head, with the nail of perpetual dependence on medical and dental practitioners, finally driven deep down into the whole length of the whole thickness of the coffin boards, by the National Health Act. 

©Awkadigwe Fredrick Ikenna 2018 (MBBS, LLB, MWACS, DSC) 
awkadigweikenna@gmail.com 

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