ENFORCING THE RIGHT TO EMERGENCY MEDICAL CARE IN NIGERIA: A LEGAL ANALYSIS OF SECTION 20 OF THE NATIONAL HEALTH ACT, 2014.

ENFORCING THE RIGHT TO EMERGENCY MEDICAL CARE IN NIGERIA: A LEGAL ANALYSIS OF SECTION 20 OF THE NATIONAL HEALTH ACT, 2014.

ABSTRACT

Access to emergency medical treatment is a foundational aspect of the right to health and human dignity. In Nigeria, Section 20 of the National Health Act, 2014 establishes a statutory obligation on healthcare providers to administer emergency care without prior demand for payment or other preconditions. Despite its legislative clarity, the actual enforcement of this right remains weak, raising concerns about justifiability, systematic gaps, and the capacity of legal institutions to protect vulnerable patients. This article undertakes a legal analysis of Section 20, placing it within the context of Nigeria’s constitutional structure, particularly the non-justiciable nature of socio-economic rights under Chapter II of the 1999 constitution. It also explored ethical obligations of healthcare professionals, relevant case laws, and regulatory policies intended to protect the right to emergency care. This paper concludes by offering targeted legal and policy reforms to strengthen the operationalization and accountability of emergency medical services in Nigeria.

Keywords: Emergency medical care, right to health, healthcare ethics.

1.0 INTRODUCTION

Emergency medical care is a cornerstone of the right to health and a fundamental determinant of life preservation in critical situations. The inability to access prompt and effective emergency treatment frequently results in preventable mortality, prolonged disability, and a violation of the inherent dignity of the human person. Across global health governance systems, the obligation o states to ensure access to emergency medical services irrespective of financial status or administrative barriers has gained significant legal and ethical recognition. The World Health Organization explicitly recognizes that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.¹

Nigeria, like many developing countries, faces systematic challenges in delivering emergency medical care, ranging from infrastructural deficits and inadequate funding to administrative inefficiencies and professional misconduct. Of particular certain is the persistent tend of healthcare provides refusing or delaying treatment unless payment is made up front.²  This practice continues to thrive despite the existence of legislativesafeguards, most notably Section 20 of the National Health Act 2014, which provides that “ a health care provider, health worker or health establishment shall not refuse a person emergency media treatment for any reason whatsoever.”³  This provision is unequivocal in its language and reflects a legislative intent to create an enforceable right. However its real world impact remains questionable. Hospitals continue to act contrary to the law, and here is little to no judicial precedent reinforcing the right to emergency treatment. The contradiction between legal entitlement and lived experience calls attention to a broader dilemma in Nigeria’s legal system: the limited enforceability of socio-economic rights, particularly those situated under Chapter II is largely viewed as non-justiciable, legislative provisions derived from its principles, such as Section 20 may suffer the same fate, unless explicitly supported by enforceable mechanisms or judicial creativity.⁴

This article critically analyses the legal status and enforceability of Section 20 of the National Health Act within Nigeria’s constitutional and healthcare context. It explores the tension between statutory provisions and constitutional limitations, the role of judicial interpretation in health rights enforcement, and the ethical duties imposed on healthcare professionals. It also draws comparative insights from other jurisdictions. It concludes with legal and policy recommendations aimed at strengthening enforceability, institutional accountability, and access to emergency care in Nigeria.

LEGAL FRAMEWORK FOR EMERGENCY MEDICAL CARE IN NIGERIA

2.0 SECTION 20 OF THE NATIONAL HEALTH ACT, 2014

The National Health Act 2014 marked a significant development in Nigeria’s healthcare legal landscape. Among its most consequential provisions is Section 20, which states

unequivocally that:

“A health care provider, health worker or health establishment shall not refuse a person emergency media treatment for any reason whatsoever” ⁵

This provision adopts a strikingly absolute and non-discretionary tone, eliminating any qualifying language that might allow exceptions. In doing so, it reflects a legislative intent to create a direct and binding obligation on healthcare professionals and institutions, both public and private, to provide emergency treatment regardless of a patient’s ability to pay, legal status, or administrative compliance.

By placing the duty squarely on the service provider, Section 20 distinguishes itself from earlier health related legal efforts in Nigeria, which often relied on aspirational or policy based language.6 Unlike provisions under the National Health Insurance Scheme or various state level health laws that were largely procedural, Section 20 attempts to create a rights-based duty of care, positioning emergency healthcare as a non-negotiable obligation.

Despite its clarity, the section’s practical enforcement is fraught with uncertainty. The Act does not define key operational terms such as “emergency”, leaving interpretation open to clinical discretion, nor does it prescribe a mechanism for redress or sanctions for violations.⁷ This absence of enforcement architecture weakens the provision’s practical effect and raises doubts if it was meant to be substantively justiciable or simply declaratory.⁸

Empirical and anecdotal evidence reveals that non-compliance with Section 20 remains widespread. Multiple media reports document instances where patients were refused urgent care due to inability to pay, leading to fatalities that could arguably have been prevented had the law been enforced.9 In many cases, there is no legal action pursued,suggesting a general public unawareness, a reluctance to litigate, or a lack of confidence in judicial outcomes.

Scholars have debated whether Section 20 creates an enforceable legal right or merely reaffirms ethical obligations already owed under medical codes of practice.¹⁰ This debate is complicated by the fact that the provision does not exist in a vacuum, rather, it is framed within a broader statutory and constitutional environment where socio-economic rights remain largely non-justiciable, as explored in the next subsection.

Furthermore, from a legal drafting perspective, Section 20 lacks express linkage to penalties or institutional oversight. There is no mention of the roles of the Medical and Dental Council of Nigeria (MDCN), hospital board, or the courts in enforcing or reviewing breaches. This limits its use as a litigation tool and arguably undercuts its value as a deterrent against unethical or unlawful conducts.¹¹

Comparative legal systems offer alterative models. In South Africa, for instance, the right  to emergency medical treatment is constitutionally entrenched under Section 27(3) of the 1996 Constitution, and courts have developed jurisprudence around its enforcement.¹² India, despite not having an explicit right to emergency treatment in its constitution, has enforced this right through judicial interpretation, notably in Parmanand Katara v Union of india, where the Supreme Court ruled that saving life must override procedural formalities.¹³ These jurisdictions show that legislative or judicial clarity can translate socio-economic rights into meaningful, enforceable entitlements.

Section 20, while commendable in intent, currently functions more as a symbolic recognition than a functional legal guarantee. Without judicial affirmation, administrative enforcement, or public advocacy, its transformative potential remains largely theoretical. For Nigeria to align with international standards and effectively protect lives, Section 20 must evolve from legislative text into a living right interpretable, enforceable, and binding in all healthcare contexts.

2.1 COMPARISON WITH CONSTITUTIONAL PROVISIONS: CHAPTER II VS CHAPTER IV

Section 20 of the National Health Act 204 must be understood in the context of Nigeria’s constitutional framework, particularly the distinction between Chapter II (Fundamental Objectives and Directive Principle of State Policy) and Chapter IV (Fundamental Rights) of the 1999 constitution. This distinction has profound implications for the enforceability of socio-economic rights, including the right to emergency medical care.

Chapter II sets out broad policy aspirations, including health, education, and social welfare, which are intended to guide the state in governance.14 For example, Section 17(3) (d) provides that the state shall ensure that “there are adequate medical and health facilities for all persons.15However, Section 6(6) (c) of the same constitution renders the provisions non-justiciable, stating that courts shall not have jurisdiction over any issue “as may relate to any question whether any act or omission… is in conformity with the Fundamental Objectives and Directives Principles”16

As a result, courts in Nigeria have traditionally held that Chapter II rights are not enforceable, even where legislative or administrative actions fall short of the expectations outlined in those provisions.17 This non-justiciability doctrine creates a critical tension when laws like the National Health Act are enacted to give statutory effect to Chapter II provisions, because the judiciary may still treat such laws as non-binding aspirations unless clearly anchored in justiciable rights.

By contrast, Chapter IV of the constitution contains civil and political rights that are enforceable in court, including the right to life (section 33) and dignity of the human person (section 34).18 Legal scholars and human rights advocates have long argued that the denial of emergency medical treatment, especially in life-threatening situations, could constitute a violation of the right to life or degrading treatment, thereby triggering the protection of Chapter IV.¹⁹

However, Nigerian courts have been cautious in making this leap. In Medical and Dental Practitioners Disciplinary Tribunal v Okonkwo, the Supreme Court reaffirmed the autonomy of patients in refusing medical treatment, but stopped short of articulating a positive duty on the state or private actors to provide life-saving care.²⁰ Unlike South Africa, where socio-economic rights are constitutionally entrenched and judicially enforced, Nigerian courts have rarely recognized positive obligations flowing from Chapter IV rights, especially in health-related matters.²¹

This legal conservatism has meant that even with Section 20 of the NHA in place, individuals denied emergency care have little constitutional footing upon which to challenge such denial. Unless the courts are willing to interpret the right to life or human dignity broadly, to include the state’s obligation to provide or guarantee emergency medical services, Section 20 remains vulnerable to judicial under-enforcement.²²

There is, however, emerging jurisprudence that suggests a possible shift. In Odafe v Attorney General of the Federation, the Federal High Court held that failure to provide medical care to prison inmates amounted to inhuman and degrading treatment.²³ Though the case did not arise from hospital denial of treatment, it demonstrates the court’s willingness to import socio-economic rights through the lens of civil rights, a promising foundation for future health rights litigation.

The challenge remains to reconcile statutory rights like Section 20 with constitutional limitations, and to develop a doctrinal bridge between socio-economic aspirations and enforceable entitlements. Without this, Nigeria’s legal system risks maintaining a divide between healthcare rights in theory and healthcare access in practice.

2.2 OTHER RELEVANT LAWS AND LEGAL INSTRUMENTS

While Section 20 of the National Health Act 2014 is a landmark provision, the right to emergency medical care in Nigeria cannot be fully understood or enforced in isolation. It is situated within a broader matrix of domestic statute, regulatory instruments, and international legal framework that collectively influence the scope, interpretation, and enforceability of emergency healthcare obligations. This section explores those complementary laws and instruments.

A. National Health Insurance Scheme (NHIS) Act

The National Health Insurance Scheme (NHIS) Act 1999 was enacted to ensure access to basic healthcare services for Nigerians.²⁴ Although not directly enforceable as a right, the scheme aims to reduce financial barriers to healthcare. However, the Act makes no specific mention of emergency treatment as a guaranteed benefit. This silence is significant, as it leaves a gap in coverage for those who might not beregistered under the scheme or who require urgent care outside the limited service structure.²⁵ In effect, the NHIS complements but does not cure the deficiencies in Section 20, particularly as it lacks universality and continues to face implementation and funding challenges.²⁶

B. The Patients’ Bill of Rights (2018)

In 2018, the Federal Government launched the Patient’s Bill of Right in collaboration with the Consumer Protection Council and the Federal Ministry of Health.27 Though not a binding law, it sets out key rights that patients should expect in health facilities, including the right to timely access to emergency care and to be treated with dignity. Its normative value lies in reinforcing the moral and professional obligations of healthcare providers. While not judicially enforceable, courts and regulators may rely on it for interpretative support when determining the standard of care or professional misconduct.²⁸

C. Regulatory Guidelines: Medical and Dental Council of Nigeria (MDCN)

The Medical and Dental Practitioners Act empowers the Medical and Dental Council of Nigeria to regulate professional misconduct.²⁹ The MDCN Code of Ethics mandates that doctors attend to emergency cases regardless of payment status, and failure to do so constitutes professional misconduct.³⁰ This complements Section 20 by providing an administrative enforcement mechanism, albeit limited to disciplinary rather than legal remedies. In the absence of court action, such professional sanctions can still serve as a form of deterrence and accountability.

D. Criminal Liability under the Criminal Code

In certain instances, a refusal to provide emergency care may amount to criminal negligence or even manslaughter under the Criminal Code Act.31 Sections 303 and 343 impose duties on persons who undertake to provide care to act without recklessness or gross negligence. While prosecutions open a potential pathway for criminal liability where a patient dies due to refusal of emergency treatment, especially if the provider’s conduct is deemed “reckless disregard for human life”.³²

E. International and Regional Human Rights Instruments

Nigeria is a signatory to several international treaties that recognize the right to health. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.³³ Similarly, Article 16 of the African Charter on Human and Peoples’ Rights guarantees the right to health and has been incorporated into Nigerian law by virtue of judicial interpretation in Abacha v Fawehinmi.³⁴ Though not self-executing, these instruments carry persuasive authority and should guide the interpretation of domestic laws such as Section 20. Moreover, international jurisprudence underlines that access to emergency care is an essential element to the life and health.³⁵ When domestic law is ambiguous, Nigerian courts are constitutionallyempowered to apply international norms to advance human rights protections.³⁶

3.0 Justiciability and Enforcement Challenges

The promise of Section 20 of the National Health Act 2014, that no person shall be denied emergency treatment, stands as a beacon of healthcare protection in Nigerian law. Yes, its transformative potential is dimmed by significant legal and practical barriers to enforcement. At the heart of these barriers lies the perennial question of justiciability: can Section 20 be meaningfully enforced in Nigerian courts? This section examines the constitutional tension surrounding socio-economic rights, judicial attitudes, and the multi- layered practical challenges that prevent this provision from achieving its intended effect.

3.1 The Constitutional Barrier: Chapter II’s Legacy

As previously discussed, Section 20 exists within a legal system where the right to health is implied but not expressly guaranteed under Chapter IV of the Constitution. Instead, health-related provisions are embedded in Chapter II, which sets out the Fundamental Objectives and Directive Principle of State Policy. 37 Section 17(3) (d) directs the state to ensure adequate medical facilities, but Section 6(6) (c) renders these provisions non- justiciable, effectively insulating the government from being legally compelled to fulfill them.³⁸ This structural limitation casts a shadow over statutory rights like Section 20. Courts in Nigeria have generally held that unless a right is expressly recognized under Chapter IV or grounded in international law with direct effect, it cannot be enforced.³⁹ While advocates have attempted to bridge the gap by arguing that denial of emergency care infringes the right to life (Section 33) or human dignity (Section 34), Nigerian courts have been reluctant to infer positive socio-economic obligations from these civil and political rights.⁴⁰

The result is a doctrinal ambiguity: does Section 20 create a standalone, enforceable obligation, or is it simply a legislative echo of Chapter II, admirable but legally toothless?

3.2 Judicial Reluctance and the Absence of Precedent

A significant obstacle to enforcement is the judiciary’s hesitance to articulate new rights or expand existing ones, particularly in the realm of socio-economic entitlements. Unlike jurisdictions such as South Africa or India, Nigerian courts have historically adopted a conservative interpretative posture, choosing to defer to the executive and legislative in matters of healthcare access.⁴¹

To date, no Nigerian appellate court has delivered a definitive ruling on the enforceability of Section 20. This judicial silence leaves both patients and practitioners in a state of uncertainty. Without precedent, trial courts are often unwilling to grant declaratory or injunctive relief in cases involving emergency treatment denial, fearing reversal or overreach.⁴²

Moreover, the lack of test cases means that even progressive judges have few legal toolswith which to advance the right. In contrast, South Africa’s Treatment Action Campaign case and India’s Parmanand Katara ruling have provided jurisprudential anchors for enforcing emergency medical care.⁴³ Nigeria, by contrast, is still waiting for such a defining moment.

3.3 Practical and Systematic Challenges

Even if Section 20 were deemed enforceable, numerous practical realities blunt its impact:

•  Lack of Awareness: A majority of Nigerians, including those most vulnerable to healthcare denial are unaware of their rights under the National Health Act.44 Without legal literacy, violations go unchallenged.
•  Financial inaccessibility of Litigation: Emergency care is needed by the poor, yet legal redress is often only available to the resourced. Legal aid in Nigeria remains limited and public interest litigation in health law is underdeveloped.45
•  Absence of Enforcement Mechanisms: Section 20 creates a duty but does not specify an enforcement procedure, leaving aggrieved individuals to rely on general civil claims, professional complaints, or criminal law, none of which is swift, affordable, or easily navigable.⁴⁶
•  Institutional Inertia: Regulatory bodies like the MDCN or CPC have limited capacity or will to pursue emergency care violations proactively.47 Enforcement often depends on complaints, and victims of emergency denial are frequently incapacitated or deceased, rendering post-incident redress hollow.
•  Healthcare Infrastructure Deficits: Finally, systematic underfunding of public hospitals, shortage of emergency units, and lack of trained personnel make real-time compliance with Section 20 logistically difficult. Legal enforceability is undermined where compliance is not just unwilling but structurally impossible.⁴⁸

3.4 The Danger of a Hollow Right

A right that cannot be enforced is, in effect, no right at all. Without judicial recognition, administrative responsiveness, and public mobilization, Section 20 risks becoming what a scholar themed “legal placebo”, a declaration that soothes public expectation without altering institutional behavior.⁴⁹

To avoid this, enforcement must be move beyond paper guarantees to practical accountability:

• Legislative amendments specifying sanctions
• Regulatory mandates for hospitals to report compliance
• Strategic litigation to test enforceability
• Public awareness campaigns to popularize the right

Until these steps are taken, the duty to provide emergency medical care in Nigeria remains aspirational, visible in law, but invisible in life.

4.0 Judicial Interpretation and Case Law

Judicial interpretation remains central to the enforcement of statutory and constitutional rights. For Section 20 of the National Health Act 2014 to have legal force, the courts must be willing to interpret it not merely as aspirational policy but as a binding, enforceable right. However, the current Nigerian jurisprudence on health-related rights reveals significant judicial caution, a sharp contrast to the bolder approaches adopted in their jurisdictions. This section analyses relevant Nigerian case law, provides comparative insights, and offers critical commentary on judicial reasoning and attitude.

4.1 Nigerian Case Law on Health Rights and Emergency Care

While no reported Nigerian case has directly tested the enforceability of Section 20, some judicial decisions reveal the courts’ general posture towards health rights. In Medical and Dental Practitioners Disciplinary Tribunal v Okonkwo, the Supreme Court upheld a patient’s right to refuse medical treatment, emphasizing the constitutional guarantee of privacy and autonomy.⁵⁰ The court framed its decision as a protection of civil liberty rather than a healthcare right, leaving open the question of whether a positive duty to provide care exists.

A more relevant case is Odafe v Attorney-General of the Federation, where the Federal High Court held that the refusal to provide medical treatment to detainees amounted to inhuman and degrading treatment under Section 34 of the Constitution.⁵¹ The court also relied on the domesticated African Charter on Human and Peoples’ Rights to support its reasoning.⁵² Although the case arose in the prison context, it set an important precedent: denial of essential medical care can constitute a violation of enforceable fundamental rights.

Nonetheless, Nigerian courts have largely refrained from interpreting socio-economic entitlements as justiciable, and no appellate court has yet ruled on whether Section 20 creates an enforceable obligation.⁵³ This silence reflects a broader judicial reluctance to engage with health-related rights, especially in the absence of express constitutional backing.

4.2 Comparative Jurisprudence: Progressive Enforcement in Other Jurisdictions

In contrast, several jurisdictions have embraced an expansive interpretation of emergency medical care rights, often grounded in constitutional or statutory socio-

economic guarantees.

India

In Permanand Katara v Union of India, the Indian Supreme Court declared that every hospital, public or private has a duty to provide immediate emergency care to injure persons without waiting for procedural formalities or upfront payment.⁵⁴ The court linked his duty directly to the constitutional right to life under Article1, holding that preservation of life must override administrative or logistic hurdles.⁵⁵ This judicial position has since been reaffirmed in multiple cases, creating a binding obligation on healthcare providers to act promptly in emergencies.

South Africa

The South African Constitutional Court, in Minister of Health v Treatment Action Campaign, held that the government’s refusal to provide antiretroviral drugs to HIV- positive pregnant women was an unjustifiable infringement of the constitutional right of healthcare under Section 27.⁵⁶ The court interpreted socio-economic rights as imposing positive obligations, and it mandated the state to adopt reasonable measures, including budgetary allocations, to realize the right.⁵⁷ This judgment is widely cited for its insistence that health rights are not merely aspirational, but enforceable through judicial mechanisms.

Kenya

Kenya’s 2010 Constitution explicitly recognizes the right to emergency medical treatment in Article 43(2). In C.K. (A Child) through Ripples International v Commissioner of Police, the High Court held that denial of post-rape emergency care violated constitutional rights to dignity and health.⁵⁸ The court affirmed that emergency healthcare is part of the minimum core obligations of the state, enforceable regardless of resource constraints.

Colombia

Colombia’s Constitutional Court has consistently enforced health rights through its tutela (constitutional complaint) system. In Case T-760/08, the court ordered wide-ranging reforms to ensure equal access to health services, affirming that denial of emergency care violated rights to life and dignity.⁵⁹ Colombian jurisprudence demonstrates how courts can drive systematic reform by interpreting healthcare rights as judicially reviewable entitlements.

4.3 Commentary on Judicial Reasoning and Attitude

The Nigerian Judiciary has thus far taken a restrained, formalist approach to socio- economic rights, particularly in the health sector. Courts have rarely gone beyond textual interpretation or procedural safeguards, even when faced with cases involving life-threatening healthcare denial. This stands in sharp contrast o the transformative and purposive reasoning adopted in India, South Africa, Kenya, and Columbia. Several factors explain this posture: a rigid separation of powers doctrine, a conservative legal culture, and the non-justiciable framing of socio-economic right in Chapter II of the constitution. Yet, Nigerian courts possess the constitutional and statutory tools to interpret Section 20 meaningfully, especially by linking it to Chapter IV rights such as life and dignity, or by invoking domesticated international instruments like the African Charter.

Ultimately, unless the judiciary embraces a rights- based and purposive interpretative lens, Section 20 may remain a dormant provision, a symbolic victory without practical effect. The growing body of comparative jurisprudence shows that courts can, and should, play a central role in realizing emergency healthcare rights, particularly for the most vulnerable.

5. Recommendations and Reform Options

The strength of a right lies not merely in its proclamation, but in its enforceability, accessibility, and institutional uptake. While Section 20 of the National Health Act 2014 lays down a progressive standard prohibiting the denial of emergency medical treatment, its impact is diluted by legal ambiguity, judicial silence, and systematic inertia. To transform this statutory duty into a livid reality, multidimensional reforms, legal, institutional, and civic, are essential. This section proposes a series of pragmatic and structural recommendation to make emergency medical care truly enforceable in Nigeria.

5.1 Strengthening Legal Enforcement Mechanisms

First, the legal architecture around Section 20 must be made explicit and actionable. At present, the provision lacks procedural clarity: it does not specify he forum for redress, the nature of sanctions, or the threshold for establishing liability. Legislative guidelines should be introduced via regulations or subsidiary legislation, detailing how aggrieved patients or their families may initiate complaints, seek compensation, or report violations.⁶⁰

Furthermore, the law should incorporate public interest standing, allowing civil society organizations, legal aid providers, or human rights institutions to bring actions on behalf of patients who are deceased, incapacitated, or otherwise unable to litigate. This aligns with existing human rights mechanisms, where access to justice is facilitated through broader standing rules.⁶¹

5.2 Legislative and Constitutional Reform

While statutory amendments can enhance Section 20 effectiveness, more enduring protection may require constitutional reform. The right to emergency medical care should be entrenched within Chapter IV of the 1999 Constitution as part of a broader justiciable right to health. This would resolve the ongoing uncertainty caused by Chapter II non- justiciability clause in Section 6(6) (c), which has stifled judicial intervention in socio- economic rights enforcement.⁶²

A constitutional amendment although procedurally demanding would elevate health rights to the level of dignity, life, and personal liberty, aligning Nigeria with modern human rights trends across Africa and Latin America. Alternatively, a dedicated Patients’ Rights Act could be enacted, codifying core healthcare entitlements, remedies, and sanctions, with clear linkages to constitutional guarantees and international obligations.⁶³

5.3 Institutional Accountability and Regulatory Oversight

Institutions responsible for healthcare delivery and regulation must be empowered and obligated to enforce Section 20 proactively. Regulatory bodies such as the Medical and Dental Council of Nigeria (MDCN) and the Federal Competition and Consumer Protection Commission (FCCPC) should be legally mandated to investigate, sanction, and publish disciplinary actions against hospitals or practitioners who deny emergency care. There should be a system of mandatory incident reporting, where healthcare facilities are required to log and disclose all cases of refused emergency treatment.⁶⁴ These logs should be audited periodically, and persistent offenders should face administrative fines, reputational sanctions, or in extreme cases, suspension of operating licenses. To ensure compliance, the Federal Ministry of Health should establish a Health Rights Monitoring Unit or hospital ombudsman system to investigate complaints and mediate disputes between patients and providers in real time.⁶⁵

5.4 Strategic Litigation and Judicial Engagement

Given the judiciary’s pivotal role in interpreting and applying Section 20, there is an urgent need for judicial engagement and capacity- building. Legal education workshops, judicial colloquia, and bench books on socio-economic rights should be introduced to assist judges in applying a purposive, rights-based interpretative method in line with international human rights jurisprudence.⁶⁶

At the same time, strategic litigation should be encouraged. Legal aid organizations and public interest law firms should identify egregious cases of emergency care denial and bring test cases to court, seeking declaratory and compensatory relief. This litigation strategy has been successfully employed in South Africa and India to establish binding legal standards and shift judicial attitude. A bold and well-argued case could prompt the Nigerian Judiciary to finally clarify the legal effect of Section 20.

5.5 Public Awareness and Legal Empowerment

Law reform is only as effective as public understanding and uptake. A major obstacle to the enforcement of Section 20 is the widespread lack of awareness among both the public and healthcare professionals. Many citizens do not know they possess the right, and many hospitals treat it as aspirational rather than obligatory. The Federal Government, in partnership with civil society, should launch a national legal awareness campaign on emergency healthcare rights. This could include:

• Translations of Section 20 into local languages
• Posters and info graphics in waiting areas
• Radios and social media campaign
• Community legal clinics in rural areas

In addition, hospital administrators and frontline staff should undergo mandatory training on patients’ rights and professional responsibilities under the National Health Act. These efforts will help normalize a culture of compliance and accountability in emergency care delivery.⁶⁷

5.6 Data Collection, Monitoring, and Evaluation

Finally, enforcement must be data-driven. The Ministry of Health should develop a centralized emergency care compliance database where hospitals report incidents of care refusal, patient outcomes, and intervention responses.⁶⁸ This data can guide policy reforms, resource allocation, and targeted enforcement.

Annual compliance reports, similar to environmental audits should be published by both regulators and independent observers. These reports would serve as transparency tools and pressure points for improved performance in the sector.

6.0 Conclusion

Section 20 of the National Health Act 2014 has the potential to be one of the most significant rights-based provisions in Nigeria’s health law history. But potential is not protection. To achieve real-world impact, it must be supported by a robust framework of legal enforceability, judicial will, regulatory oversight, and civic mobilization. Only through such an integrated reform approach can Nigeria ensure that no person is denied emergency medical treatment, not just in law, but in lived experience.

 

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50 Medical and Dental Practitioners Disciplinary Tribunal v Okonkwo [2001] 7 NWLR (Pt. 711) 206 (SC)

51 Odafe v Attorney General of the Federation (2004) AHRLR 205 (NgHC 2004)

52African Charter on Human and Peoples’ Rights (ratified and domesticated as Cap A9 LFN 2004), art 16

53 Abiola Sanni, ‘Enforceability of the Fundamental Objectives and Directive Principles in Nigeria: A legal

illusion? (2006) 2(1) University of Ilorin Law Journal 15, 20.

54 Permanand Katara v Union of India [1989] AIR2039 (SC) India

55 Ibid[6]

56 Minister of Health v Treatment Action Campaign (2002) ZACC 15, 2002 (5) SA 721 (CC) (South Africa)

57 Ibid [6]

58 C.K. (A Child) through Ripples International v Commissioner of Police [2013] eKLR (Kenya High Court)

59 Tutela Case T-760/08 (Colombian Constitutional Court, 2008)

60 National Health Act 2014, s20.

61 Abiola Sanni, ‘Expanding Standing in Public Interest Litigation in Nigeria’ (2021) 12(1) Nigerian Journal

of Human Rights Practice 34.

62 Constitution of the Federal Republic of Nigeria 1999(as amended), s6 (6) (c).

63 Akin Oyebode, ‘Justiciable Health Rights in Nigeria: The Case for Legislative Intervention’ (2020) 4(2)

Nigerian Health Policy Review 67.

64 Federal Ministry of Health, ‘National Health Sector Accountability Framework’ (2022)

https://dgiconsult.org/harmonized-bhcpf-accountability-framework-ready-for-

rollout/#:~:text=The%20multi%2Dlevel%20accountability%20framework,outcome%20through%20the%20

primary%20healthcare, accessed 7 July 2025.

65 WHO, Accountability Mechanisms for the Right to Health (2019)

https://iris.who.int/bitstream/handle/10665/312282/9789289054096-eng.pdf accessed 7 July 2025.

66 Open Society Foundations, Bringing Justice to Health (2013)

https://www.opensocietyfoundations.org/uploads/7af19455-93f3-4717-8131-60764b4fd475/justice-

programs-public-health-20150701_1.pdf accessed 7 July 2025.

67 Funmi Ogun, Health Law Education for Medical Practitioners in Nigeria: Gaps and Opportunities (2022)

6(1) Journal of Medical Law and Ethics in Africa 48.

68 WHO African Region, Health Information Systems Strategy (2021) https://www.afro.who.int/health-

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