Relief as Nigeria on threshold of medical tourism reversal

The vice-president, Kashim Shettima, may not be wrong after all when he said recently that there is a gradual downward trend in the ‘annoying’ medical tourism practice by public officials. SUNNY IDACHABA in this report examines efforts so far in that regard.

Despite the calls by respected individuals on past administrations to stamp out the medical tourism regime by public officials, no former president had the political will to do so or even make a pronouncement in affirmation of the call for reasons that bother on a deficient medical infrastructure. Therefore, travelling abroad to treat every ailment was their first and immediate option.

However, it was the immediate past president, Muhammadu Buhari, who during his campaign days preceding the 2015 general elections that declared if voted into office, he would end the era of public officials flying into overseas countries to treat various ailments, as according to him, the practice had robbed the country of valuable foreign exchange of which, he said, the nation cannot afford to continue in that lifestyle.

According to Buhari, “The government’s hard-earned cash, external, would not be spent on treating officials overseas, especially when Nigeria had the expertise.”

Ironically, when eventually voted into office, he never kept a date with that promise as he not only went in and out of overseas hospitals, but took it to another level; for instance, at a point in the life of his administration, he took up a permanent shelter abroad while his deputy, Prof. Yemi Osinbajo, held sway as acting president.

As an example, shortly after assuming office, Buhari flew to London to be treated for an ear infection that Nigeria has enough Ear Nose and Throat (ENT) specialists to handle.

This prompted then vice president of the Commonwealth Medical Association, Dr. Osahon Enabule, to describe it as a national shame, saying, “Buhari should lead by example by using Nigerian doctors and facilities and ensure that government officials do not go abroad on frivolous medical trips.”

In the same way, current President Bola Tinubu on assuming office in May 2023 did not hide his preference for medical treatment abroad as he often flew out on private visits only to be spotted in some medical facilities abroad. 

Also, it seems that almost every elected public official has personal and family medical record files in overseas hospitals all at the expense of public funds, even though they are officially denied. This has been the trend over the years. 

However, there seems to be a silver lining or a somewhat shift from that trend in what looks like better days in Nigeria’s medical history. 

For instance, recently, the vice-president, Kashim Shettima, admitted while playing host to the Nigerian Association of Nephrology (NAN) at the Presidential Villa ahead of the association’s 37th scientific conference that Nigeria is witnessing a surge in reverse medical tourism with patients from the United States and other countries thronging the nation’s hospitals to seek affordable and high-quality kidney transplants, a development he attributed to affordability of treatment and high-quality expertise within the nation’s medical community.

In a statement by his spokesperson, Mr. Stanley Nkwocha, Shettima stressed the need for further investments in specialised medical education to sustain this progress.

“There is reverse medical tourism these days fundamentally because of the level of care at some of our hospitals. Recently, 13 patients from the United States came to Nigeria for kidney transplants at Zenith Medical and Kidney Centre because it is much cheaper here and they received the same level of expertise available anywhere in the world.”

While acknowledging what kidney patients in particular go through even after a successful transplant, Shettima noted the financial strain as many, he noted, would sell their homes or rely on the government for support.

“While getting a kidney transplant is a significant challenge, life after a transplant presents even more difficulties. Many patients struggle with the cost of post-transplant care, including immunosuppressants, essential to maintaining their health. We must make deliberate and targeted investments in specialised healthcare education in this country.”

Stark, disturbing reality

In 2013, it was estimated that Nigerians spent $1 billion (£690 million) on foreign medical trips.

Also, according to the Central Bank of Nigeria’s balance of payment review from 2011 to 2021, record shows that medical tourism had cost the nation a whopping $11.01 billion with an average of $1billion yearly  according to another report by the Nigerian Sovereign Investment Authority (NSIA).

Alarmingly, the year 2019 saw the highest overseas health-related expenditure at $2.56 billion, the same year that a meagre sum of $757.920 million amounting to N315.62 billion was budgeted for the health sector.

Remediation through legislation

Irked by this cost and foreign exchange fleece, a lawmaker who once represented Esan North East/Esan South East of Edo state in the House of Representatives, Sergius Ogun, took on the gauntlet when he sponsored a bill, ‘An Act to Amend the National Health Act, 2014 and for Related Matters’ in which he prescribed a seven-year jail term or N500 million fine for any public officials that uses public funds for medical trips abroad.

According to the lawmaker, “This bill, which seeks to amend the National Health Act, is borne out of a desire to discourage medical treatment abroad at the detriment of our indigenous health institutions. The need to revamp the poor state of the health care sector in Nigeria, among other things, is the reason for introducing this bill.”

He said, “It is no news that Nigeria’s healthcare system is in a deplorable state and needs urgent attention. There is paucity of infrastructure, dearth of medical personnel, poor standards and many other challenges that need to be addressed. The intent of this bill is to spur public officers to pay more attention to our healthcare sector and take drastic steps to develop and improve on the sector.”

A part of the bill also reads, “Without prejudice to the right of any Nigerian to seek medical check-up, investigation or treatment anywhere within and outside Nigeria, no public officer of the government of the federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense, except in exceptional cases on the recommendation and referral by the medical board and which recommendation and referral shall be duly approved by the minister or commissioner of health of the state as the case may be.”

This was in 2014; for inexplicable reason(s), that bill suffered ‘stillbirth’ as the trend continued at the highest level of governance without any challenge.

The brain-drain challenge

At the moment, reversing the trend of medical tourism remains a herculean task considering the widespread brain-drain in the sector which was recently exacerbated by the japa syndrome. For instance, in the year 2021, the UK General Medical Council data shows that about 9,189 medical doctors of Nigeria origin were practising there. 

It could be recalled that in the same year, the Saudi Arabia health ministry recruited over 500 medical doctors out of Nigeria. These are yet to return. As of today, the trend has left Nigeria with a poor ratio of 4 doctors attending to almost 10,000 patients. Even with this development, more medically-trained persons are willing to migrate given the slightest opportunity.

Private initiative to the rescue

While writing on private initiative to checkmate the incidences of seeking medical attention abroad, an analyst, Adeyinka Salami said a private university, Godwin Maduka Medical University, (Atlantic Medical School) stands out as a hope and proof to the berthing of medical excellence in Nigeria and the rest of Africa and beyond.

He said, “Thousands of Nigerians travel abroad yearly for medical tourism, ranging from routine check-ups to complex surgeries with the attendant cost of an estimated $1 billion yearly to the nation.

“This has been a drain pipe to the country’s valuable financial resources and underscores critical gaps in its health care system. It is based on this that a Nigerian America-based medical doctor and philanthropist, Dr. Maduka, envisioned the first of its kind medical university to reverse the trend.

“The transformative opportunity that has emerged with the establishment of Godwin Maduka’s Medical University would assist Nigeria in making significant strides toward addressing its health care deficits and curbing the tide of medical tourism.”

All these, he said, were authenticated by a high-powered delegation of the National Universities Commission (NUC) led by its former executive secretary Mr Chris Maiyaki which visited the yet-to-be commissioned medical varsity and expressed satisfaction with the quality of the structure put in place there.

“Beyond education and research, the university hospital is equipped with modern medical equipment and facilities, providing high-quality healthcare services that can rival those found in medical tourism destinations. This will offer Nigerians access to superior medical care within their country.”

It is for these reasons that one may agree with what the vice president meant when he said that Nigeria is gradually becoming a medical destination in Africa. What, however, remains to be done is that leaders would lead by example in proving to Nigerians that whatever medical facility they are looking for abroad are here with us in order to promote ours.