Medical tourism has eaten deep in Nigeria to the extent that those who cannot afford it have resorted to either selling their properties, begging relatives and friends or borrowing to send their loved ones or selves to other countries to seek medical help that is available in Nigeria, reports Deborah Musa

For the affluent, going abroad for medical tourism is no big deal because the money is always available in face of the poorly maintained public health sector in Nigeria. The middle class, who struggle to go abroad for the same medical treatments are no longer finding it easy, while the masses and the low class have no option but to continue to visit the deplorable facilities in Nigeria, which in some cases, have been tagged ‘death traps’.

Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this was usually referred to as those who travelled from less-developed countries to major medical centres in highly developed countries for treatment unavailable at home.

Nigerians travel to countries like India, China, South Africa, Malaysia, Dubai, the United States, and the United Kingdom. Wealthy Nigerians make the UK and US their target place for health care

Medical tourism has contributed immensely to the growth and development of the health care system in the countries that engage in it because it attracts people from various parts of the world, thereby adding value to the countries involved but how does this benefit Nigeria? It doesn’t because we have no medical tourist

Rather, in Nigeria alone, travel to India for healthcare generated more than $260m in spending in 2019.

According to Price Waterhouse Coopers (2016) report, Nigerians spend $1bn annually on medical tourism with 60 per cent of it on four key specialties namely: oncology, orthopaedics, nephrology, and cardiology.

This is nearly 20 per cent of the total government spending on the public health sector for the year, including salaries of all public sector doctors, nurses, and other healthcare workers as well as other health programmes like malaria, tuberculosis, polio, and HIV/AIDS prevention as total government expenditure on health sector for the year 2015 which stood at $5.85bn.

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Statistics from the National Association of Resident Doctors (NARD) indicate that about N576bn ($1.2bn) is spent on medical tourism yearly in Nigeria, an amount that could have been invested in the development of the country’s health care system and the country as a whole. This is about N100 billion less than the N632.7 billion allocated to the health sector in the 2021 budget.

Nigerians have for decades suffered from an inadequately funded healthcare system, poor clinic structures and hospitals that are underequipped, poorly paid, and overworked healthcare workers who frequently move abroad for employment.

There are at least 8,178 medical doctors of Nigerian origin working in the U.K., according to data on the U.K. General Medical Council website. The exodus has worsened healthcare in a country that has one doctor for every 5,000 people, according to the Nigeria Medical Association (NMA).

Talking medical tourism in Nigeria has always been a thing of the elite but the President Muhammadu Buhari’s administration as president of the country crowned it all. His frequent medical travels outside the country got the tongues of Nigerians wagging.

A leader is supposed to lead by example, but how can Nigerians have faith in the medical care available in the country when the President does not, a rhetorical question was asked.

The country spent huge sums of money recently to refurbish the Aso Rock clinic. In its 2021 budget, the President allocated N17.3bn to the State House Clinic, which he seldom uses. The presidential clinic is designed to cater to the President, Vice President, their families, and members of staff of the Presidential Villa, Abuja.

However, the First Lady, Aisha Buhari, had lamented the lack of facilities including syringes in the State House Clinic, adding that the facility does not have functional X-ray machines when she went there for treatment.

From the records, Buhari had long overtaken the former President Umar Yar’Adua in medical trips abroad by spending 172 days outside Nigeria within his first two years in office.

•Health budgets so far under Buhari

In 2016, the Ministry of Health received N250bn, while the State House Medical Centre got N2.8bn In 2017, N304.1bn was allocated to the Ministry of Health and N331.7m to the State House Medical Centre.

The 2018 budget indicated that the ministry had N356.4bn, while the presidential clinic received N1bn. In 2019, N372.7bn went to the ministry and the Villa medical centre got N798.8m. In 2020, N414.4bn was budgeted for health as against N598.6m for the State House Medical Centre. The 2021 budget allocated N549.8bn to the Ministry of Health and N641.1m for the presidential clinic.

Buhari signed N17.16trn for 2022 out of which N724bn (4.2 per cent) was allocated for healthcare across the 36 states of the federation and the Federal Capital Territory.

With the meagre amount allocated, Nigeria again failed to meet its Abuja Declaration commitment which requires the nation to ensure that 15 per cent of its annual budgetary allocation goes to health

While there may be an increase in what is budgeted compared to recent years, the fact is that there isn’t much gain when the variables of inflation rate and increase in population are considered.

For instance, the approved 2022 budget was scaled up by 24 per cent in comparison with the N549.8bn budgeted for the sector in 2021.

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However, in the actual sense of it, the increase makes no difference because of the inflation rate in the country

Speaking with ThisNigeria, the immediate past National President, National Association of Resident Doctors, NARD, Dr Aliyu Sokomba, said, “The problem isn’t why people choose to patronise medical care abroad is because the facilities in the country are not good enough and the reason why these facilities are not good enough is that they are not funded and the reason why these politicians don’t fund them is that they can always seek care outside.

“It is like a circle that you don’t know where to begin to address it and the people who are supposed to put up laws to stop the tourism are the same people who have not done the needful to ensure that the health care system in the country is strengthened.

“Even the president of the Federal Republic of Nigeria is guilty of it so, who wants to solve it? If they know that they can always go outside to get a cure for something as simple as a headache, why will they bother themselves equipping the hospitals in Nigeria when they can always get out to get the healthcare they need.

“Why will they bother about fixing the hospitals in the country when their families can always go out of the country to get the healthcare they need. So it’s becoming recurrent that the politicians who are supposed to fix the system, can go out to get care, so they don’t see the need to fix it.

“There’s no law against it, the people are supposed to be responsible and put up laws against this kind of activities are busy patronising medical tourism themselves so, I don’t see it as a thing that would end in the nearest future.

“Everything is about priority. We have a docile population of people who do not know what they are expected to expect from their government so the government does not care, the government will rather budget billions of money to take care of projects that nobody sees or cares about, instead of spending the money to make healthcare available for the people.”

He lamented that the health budget over the years had been abysmally low, far below the stipulated allocation by the World Health Organisation (WHO).

“The budget for health is abysmally low, it is not anything to talk about. The World Health Organisation, WHO, considered resourceful nations like Nigeria, had a meeting in think 2000/2001, that 15 per cent of their budget be given to health to strengthen their healthcare system in the country.

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“Nigeria was a signatory to that accord eight here in Abuja but the last time I checked, the budget for health in the country was as low as five per cent against what is expected of 15 per cent of the total budgetary allocation.

“So you see, everything is about priority, nobody is worried, nobody cares, so people are allowed to just wallow in their suffering and continue to dabble with the food they have. As far as the rich and affluence are concerned, they can always get out of the country,” Sokomba lamented.

Also, the President of the Nigeria Medical Association (NMA), Prof. Innocent Ujah, said medical tourism and brain drain are the twin evil in the health system in Nigeria.

He lamented that the twin monster of brain drain and medical tourism seems to have a bi-directional relationship, which implies that one will lead to the other and vice-versa.

He said, “Nigerians are said to spend over $1bn annually on medical tourism, according to a Price Waterhouse Cooper’s report in 2016. This represents a significant capital flight from the country which further weakens our economy with great consequences, such as reduced funding/investment in the health sector, widening infrastructural deficits, and the growing distrust in the Nigerian health system by the Nigerian public.”

He decried the huge number of emigrations of Nigerian medical doctors and other workers to other countries of the world in search of a better work environment, safety, and security for themselves and their families.