Reversing medical tourism in Nigeria

With the increasing population of Nigerians exiting the country to seek medical treatment abroad and the huge impact on the nation’s economy, it has become a matter of urgency to revamp the health sector to edge the ugly trend.

Tens of thousands of Nigerians travel every year to the United States of America, (USA), United Kingdom, (UK), India, Thailand, Turkey, France, Canada, Germany Malaysia, Singapore, Saudi Arabia and China, among other countries for treatments ranging from kidney transplant, open heart or cardiac surgeries, neurosurgeries, cosmetic surgeries, orthopedic surgeries, eye surgery and other health conditions, to the extent of delivering babies over there.

It is estimated that Nigeria loses about $1.3 billion to medical tourism yearly, which has caused a huge burden on the nation’s economy.

The inadequacy of Nigeria’s health system has been traced to the thriving foreign medical tourism due to poor service delivery, poor funding, unavailability of human capital, poor infrastructure and absence of specialist services, among other flaws.

And according to the World Health Organisation (WHO), Nigeria is currently ranked 187 out of 190 countries in the health index.

While the country is suffering from the alarming rate of medical tourism, brain drain has also been linked to the ugly trend as the best physicians are leaving the country to seek better paying job and working environment abroad, especially the US and Canada where they would be respected.

The Secretary of the Board Trustees, Nigerian-American Medical Foundation (NAMF), Dr. Adeyinka Shoroye in an interview with The Guardian said according to the a count done by the foundation with the American Medical Association (AMA) in 1995, Nigerian doctors by birth in the US was about 1,200, noting that by April 2018, another count was done, which showed an increase of 4,500.

He stressed that human capital; infrastructure, poor quality of education and funding have contributed immensely to the poor state of the country’s health system.

“Misplaced priorities, no proper funding for health care budget, no education, in many universities we don’t have enough faculty for medicine the teaching staff are inadequate and they are overstretching the system to get the best training, this is human life and medicine.

“Basically, people are leaving the country because tertiary care is not doing very well, it has failed due to poor funding and the educational standard has gone so bad in the last three decades, the effect is what we are seeing.

“Failed primary healthcare, uncoordinated tertiary health care, corruption and mismanagement, of course, we are all seeing the effect now. Those who can afforded treatment go to Europe, North America or South Africa which has a very good infrastructure and those that can not afford it stay in the country. People are leaving the country, because they want to get better healthcare at the super-tertiary level. We all know the massive outflow of doctors who left the country in the last two decades practices somewhere in the North America and the whole idea is, even those who don’t want to come back home, if there is a way for them to come in and voluntary, especially the area people are leaving for tourism, which is the super-tertiary care, then we can fill that gap, which is the whole idea of reversing medial tourism,” he said.

He recalled that during the days of the former president of Nigeria, Gen. Yakubu Gowon, the National Health Development Plan I was developed, adding that funding in the universities was sufficient, which included the medical schools, which are Ahmadu Bello University (ABU), University of Nigeria Nsukka (UNN), University of Lagos, University of Ibadan, University of Ife, that produced excellent graduate, according to him, who later left the country.

Shoroye lamented that with the way the population is growing, policy makers at the local, state or federal level should be intensify efforts at addressing the issue.

“Nigeria’s population is a scary phenomenon, we are not preparing for the future, and we are now in the second decade of the 21st century, 2018. By the years 2050, the UNDP is saying Nigeria’s population will be the number three in the world. Right now China is 1.4billion people, India is 1.3billion, US is 325million, Indonesia is 270 million, Brazil is 210million, Pakistan is 207million, with the figures we are having now Nigeria is 198milllion, which is almost 200million; we are getting close to Pakistan, we are number seven and we will overtake Pakistan, which is very close as well as Brazil, Indonesia and US, that means by 2050 Nigeria will be the third most populous country globally.

“And we are not planning infrastructure, education and human capital. Infrastructure can even be the number two, you can have any fine structure but what about the people, the human capital that will be able to sustain… so those are the things we are looking at, it may not be in our own time but let us look at fairness to the next generation coming that it is a challenge they would have to face. Population is ticking time bomb, even if the population is growing are people sitting down to look at statistics and planning well for the future, even the state of the economy.”

He added that most of the countries in the world with the best human indices in healthcare have high standard of living, which has led to the lowest maternal and infant mortality and very high life expectancy.

Proffering solution to the ravaging problems, Shoroye said NAMFI is working towards strengthening the primary health care in the country from the local government wards, making it stronger and very effective, adding that once that is done, the secondary and tertiary healthcare level would have lesser problem.

“If we make the primary health care stronger there will be less problems for the secondary and tertiary health care level. Of course there is super-tertiary which is what we are dealing with in this foundation.

“The human capital is a luxury and we are all glad that this is a golden opportunity to tap into that. Yes they don’t live here, some might not want to come back, but at least, they can be volunteers and rotate periodically. If we have 12 experts in one particular narrow sub-specialty, they can pick a month each, come home two or three weeks do consultation, it might not be the best, but it is better than nothing.

He stressed that Nigeria accounts for the highest burden of non communicable diseases, adding “The figures we have now from WHO, state that the developed world has a 47-per cent increase in the last few years, in the developing country 60 per cent increase and that is the problem, we are not just battling with the old problem, we have made some strides in communicable and infectious diseases, remunerations have made big difference in the last century, but in this 21st century one of the challenges we have now is the NCDs, and what ways are we going to screen and address them, it is at the primary health care level, at least that is the challenge we are going to face for a while in the next generation of this part of the world and we are not taking them seriously.”

He lauded the federal government’s effort in revitalizing 10, 000 PHCs across the country urging the current policy makers to take it serious, adding “if you strengthen primary care, it will become less problem for secondary and tertiary health care level and also for the super-tertiary, but when you have ignored that one, from uncontrollable hypertension to kidney transplant and now they are looking for funds to travel to do transplant.

“The problem start from prevention which could be done at the primary care level by strengthening it, so it is laudable, but there are other things behind the scene that we need to be aware of between the kind of living of the people with those indices.”

On what NAMFI intends to do to stem medical tourism in Nigeria, Shoroye said the foundation would invest in human capital by engaging the Nigerian doctors in the diaspora to render medical service here in Nigeria, either periodically by medical missions or volunteers, adding that it would help the country for a long time.

“We are hoping that we can be able to attract them to come and work here.
We have a huge human capital in front of us to be able to move forward, which is a big plus,” he added.

On sustainability, he said, “it is not going to be easy, it is a huge population, at least we have to start somewhere, even if it is just a single referral centre, it is a good beginning, we can’t solve everything in one day, but it is better than doing nothing because it is easy to start something and stop, but is it better to sustain it. These are going to be driven by data and we will get there.”

“We had this 10-year master plan for infrastructure. The challenges are there.
One thing we have carefully done is this donor mentality, looking for foreign aid, we are not going to be looking for funding from any foreign bodies, and we have the wherewithal to put things in place. The 10-year master plan, hopefully by 2024, it would be achieved.”