Counting the cost of medical tourism
For many years, Nigeria’s healthcare system and infrastructure have been consistently ranked one of the poorest given the size of its economy and earnings from resources. What is often overlooked is how medical tourism among the country’s political elite remains a salient but overlooked cause of poor health systems and infrastructure. The lack of confidence in the health systems they oversee and the fact that they can afford the trips given that the expenses are paid for by taxpayers, remain a motivation for the ineptitude and flagrant disregard for the people and constitution they promise to defend. After at least 237 days of medical trips by President Muhammadu Buhari since 2015, Nigerians have cause to worry about who they vote for next year. Voting leaders that are not committed to what they preach will further drag a borrowing nation with weak soft power to its knees.
Every time African leaders hop on plane for medical tourism, countries pay a heavy price for this bad behaviour. The Federal Government recently said that Nigerians spend between $1.2 and $1.6 billion on medical tourism yearly but was silent about how much of that is borne by taxpayers on behalf of political elite. It is estimated that in Uganda, the funds spent to treat top government officials abroad every year could build 10 hospitals. Not only do the leaders travel with elaborate entourages but they also travel in expensive chartered jets. For example, the cost of parking Buhari’s plane during his London trip in 2017 is estimated at £360,000 – equivalent to 0.07 per cent of Nigeria’s budget allocation for health in that same year.
President Buhari’s medical tourism record, which is unprecedented in Nigeria’s history, as well, costs the country in medical bills and operating cost of the Nigerian Air Force One (NAF 001) airplane. The Guardian estimate showed that the trips already cost between N1.1 billion to N5.4 billion in sundry operational costs, including fuel, landing and parking charges. Stakeholders reckon that the presidential extravagance is fueling steady rise in the yearly budget of the Presidential Air Fleet (PAF) – contrary to Buhari’s pre-2015 promises to cut running cost of presidential jets. For many, the budget should be seen as a conservative figure, as the actual costs could be worse.
At a time the nation is borrowing to survive, Buhari has since 2016 been taking care of himself, religiously. For too long, Nigeria has spent too much money on frivolities and has failed to make critical investments in the health sector, citing paucity of funds. But there are other developing nations that have been able to turn around their health systems even in the midst of scarcity. President of Rwanda, Paul Kagame, received commendation at the World Health Assembly in 2018 for attaining Universal Health Coverage of 90 per cent in a country, which 24 years earlier collapsed due to a civil war. In contrast, Nigeria’s health coverage stands at a paltry 5.0 per cent.
With poor investment in the Nigeria’s healthcare system, Indian healthcare entrepreneurs and investors are already making significant moves to corner Africa’s medical tourism market by branching into the continent. Apollo Hospitals, India’s biggest healthcare chain, invested in a $70 million, 500-bed hospital in Dar es Salaam, Tanzania. This multi-specialist facility is intended to serve patients and ‘would-be medical tourists’ in the East Africa region. Another Indian medical company, Biohealth, announced an investment of $5 million in a health facility on the continent for comprehensive cardiology diagnostics, dialysis, and radiology. In Nigeria, private sector investment in the sector has moderately increased in order to take a share of the medical tourism pie. Despite these investments, Nigeria has seen a steady decline in the number of healthcare workers. The doctor/patient ratio is 1:3,500 and getting worse. The country has consistently failed to invest in its health sector because there is no incentive to do so since public officials have the option of patronising foreign hospitals, often at taxpayers’ expense. The result has been the neglect and the poor capacity of the public health sector to effectively tackle preventable diseases like Lassa fever, cholera, meningitis and yellow fever.
The WHO says the health indicators for Nigeria are among the worst in the world. Nigeria shoulders 10 per cent of the global disease burden. It has the highest rate of malaria infections and the third highest HIV burden on earth. The country has very high infant and maternal mortality rates such that the risk of a woman dying in pregnancy or childbirth is one in 15, compared to one in 5,000 in developed nations.
For next year, Buhari’s government budgeted N297 million for the National Health Insurance Scheme (NHIS), but plans to spend about N2.5 billion on the President’s local and foreign trips. This is despite the poor healthcare system in the country and the high rate of poverty orchestrated by the poor economic state, which has made it almost impossible for millions of Nigerians living below the poverty line to afford healthcare services even at the primary level. Buhari can learn from Rwanda’s experience as the Bill Gates Foundation reports: In 1994, its entire health system was in ruins. The country was in the midst of a brutal genocide that claimed the lives of as many as one million people, including many of the country’s doctors and health workers. Many others fled. Today, Rwanda is about the best place for investors in Africa. It has even become the poster boy for the continent.
The recent meeting between King Charles III and President Buhari in Buckingham Palace where the latter was asked if he has a house in the UK, appears to be a sarcastic discussion misunderstood and misinterpreted by the President’s handlers to showcase his incorruptible nature. For someone that mostly patronises the British health care system, the President must note that there is nothing honourable about a leader who seeks medical help abroad, but abandons his people to bear the brunt of a decaying health sector worsened by the incompetence and failure of his administration in many respects. With less than seven months left for him to complete his tenure, the question remains; what sort of legacy does Buhari hope to leave behind?
As elections near, Nigerians need to be wary of electing leaders that will use their taxes and commonwealth to take care of undisclosed ailments. Though the constitution is silent on healthcare disclosures, it has become necessary to make laws to check abuse of public office holders since morality may never prevail. Serious leaders do not take the security of their nation for granted nor rule from another country. For a nation borrowing to sustain an opulent lifestyle of its rulers on the one hand, and seeking debt relief on the other hand, the joke is taken too far. Now is the time for Nigerians to seek leaders who truly place the country’s interests above their self-interest.