ELECTING not to join the elitist game of medical tourism, Vice-President Yemi Osinbajo has drawn attention to the decay in the domestic health sector and Nigeria’s poor leadership. In a well-publicised episode, the VP put the sector under public scrutiny by having a surgery done in Lagos. In opting for local care, he brushed aside advice from several quarters to travel abroad as is the wont of most public office holders when they fall ill. Nigeria’s insensitive and self-indulgent political class, exemplified by the President, Major General Muhammadu Buhari (retd.), should take a leaf out of Osinbajo’s book.
On the bright side, Osinbajo’s local procedure would have saved Nigeria from using scarce foreign exchange for his treatment overseas, no matter how small. If Nigeria had a conscionable leadership, it would have consolidated on the VP’s act. But if experience and the rot in the health system is a guide, the moment will likely pass as an ephemeral tonic.
Truly, the Buhari regime made heavy weather of Osinbajo’s preference. Instead of travelling overseas as the country’s elite do – even for minor ailments –, the VP, who reportedly suffered a leg injury during a game of squash, chose to have the surgery in Nigeria. Ecstatic, Nigeria’s medical community described it as vote of confidence for a much maligned and neglected sector by successive governments at every level.
Certainly, there is some merit to this. Nigerian hospitals have successfully conducted major operations, including open-heart surgeries, kidney transplants and separation of Siamese twins. Osinbajo’s successful surgery is another plus. Medical practitioners from Nigeria are highly regarded across the world.
Despite this bright side, there are deep-seated issues encumbering the sector. Medical tourism constitutes a colossal financial drain on Nigeria. The Nigerian Medical Association says the country spends $1 billion annually on it. Medical and education tourism combined drains $10 billion from the country annually, said Godwin Emefiele, the Central Bank of Nigeria Governor.
Across the country, public healthcare infrastructure – hospitals, clinics, laboratories –is dilapidated. Most of the equipment needed is imported, making them expensive and cost of treatment out of reach for most citizens. Consequently, emergencies claim many lives and many fatalities are avoidable. Existing equipment is broken and ill-maintained.
By NMA data, only 40,000 of the over 80,000 medical doctors registered with the Medical and Dental Council of Nigeria practise at home. The others work overseas. That gives Nigeria a doctor-to-patient ratio of 1:4,000-1:5,000 as against the 1:600 recommended by the WHO. The Pharmaceutical Society of Nigeria said 5,000 of the registered 30,000 pharmacists in Nigeria had travelled out of the country as of 2019.
Meanwhile, the country contributes 34 per cent to the global maternal deaths. It means one in 22 women is likely to die in pregnancy or during delivery, compared to one in 4,900 in the developed world, says the WHO. In 2019, Nigeria overtook India as the highest contributor to global under-five deaths with 858,000 against India’s 824,000 deaths.
Additionally, Nigeria houses the highest number of the poor in the world, which makes treatment very expensive and out of reach to many simply because drugs are mostly imported. Drugs will cost more as the naira loses value and domestic drug manufacturers, hit by higher costs, struggle to stay afloat.
There are more perspectives to Osinbajo’s choice. Painfully, it reinforces the decrepit health system in Nigeria, one in which the elite does not repose any iota of confidence. From Buhari to the governors, all they do is pay lip service to the health sector. Whenever they require medical treatment, they take the next available flight out of the country. They have completely abandoned their responsibility to provide qualitative health care services and infrastructure.
In Buhari’s case, the British health system has literally sustained his health. Shortly after assuming office, he started embarking on medical trips to the United Kingdom. By the calculations of The PUNCH, Buhari had spent 201 days in total on medical tourism to the UK as of August 2021. Borne by the hard-pressed taxpayer, the cost is staggering.
There is a lengthy list of high-profile politicians who have spurned treatment at home in preference for medical tourism. India, Europe, the Middle East, and the United States are their major destinations. At different times, the presidential candidates of the major political parties have also opted for medical tourism. Many other political figures are enamoured of foreign medical treatment.
A former Deputy Senate President, Ike Ekweremadu, is currently battling to replace his daughter’s kidney in a UK hospital and along with his wife, is ensnared in a criminal prosecution. In an episode that graphically captures Nigeria’s shame, a former President, Umaru Yar’Adua, sought treatment for pericarditis in Germany and Saudi Arabia before dying in office in May 2010.
Therefore, there should be an integrated approach to mend the broken system. The President and state governors can take the initial drastic step of insisting that serving political appointees should not engage in medical tourism. The federal and state governments should also not foot the bill of any official, serving, or former that opts for overseas medical treatment. This should trigger comprehensive corrective action to fix the domestic health institutions.
There should be real investment – from the training of professionals to the retention of their services through adequate remuneration – and provision, upgrade, and maintenance of health infrastructure. More resources should be committed to the sector by all levels of government.
Most critically, Nigeria should build from bottom up, which is the case in Cuba, adjudged by the WHO as having the best-run health system in the world. There, primary healthcare takes precedence. In Nigeria, the secondary and tertiary health institutions are overburdened because the primary healthcare system has virtually collapsed. Reviving it should be a priority for the state governments. The requisite staff should be trained and constantly re-trained for this task.
Ultimately, the National Health Insurance Scheme should be reviewed, expanded, and made more accessible to all Nigerians.
