African
countries have been expending massive sums of money in the area of
medical tourism over the failure of generations to develop the local
medical systems.
When News Breaks Out, We Break In. (The 2014 Bloggies Finalist)
President Muhammadu Buhari
African countries have a lot in common, including a tapestry of
shared cultural and economic practices. True, there are numerous
relatively distinct ethnic groups across the continent, a shared pattern
of social, cultural, and economic practices is discernible.
Equally discernible is the shared pattern of political behaviour
and stunted development across the continent. The most frequently
identified factors responsible for this situation are poor leadership,
weak institutions, governance failure, and endemic corruption.
One of the consequences of these shortcomings is poor health care
across the continent. Save for a few private hospitals, whose charges
are very high, most hospitals across the continent are poorly funded,
under-equipped and poorly staffed. Many hospital laboratories lack the
equipment and tools for the most basic lab tests, while their pharmacies
run out of basic drugs like pain killers, antibiotics, and
anti-malarial medicines.
It is the poor – health care system in Africa that popularised
medical tourism – the practice of travelling abroad to obtain medical
treatment-on the continent. For Africans, medical tourism destinations
include North America, Europe, the Middle East, and parts of Asia,
especially India. South Africa is the only known medical tourism
destination in Africa.
In 2016 alone, Africans spent well over $6bn on medical tourism,
with Nigerians accounting for over $2bn. These could only be
conservative estimates as we often do not know how much government
officials spend abroad on medical care. What we do know for sure is that
the Nigerian federal and state governments spent less than the above
amount on health care facilities in 2016. Indeed, the Federal
Government’s health budget for 2016 was only about $800m. Worse still,
not all of it was released and, of the amount released, a reasonable
portion of it must have been misappropriated.
As indicated above, Nigeria is the leading producer of medical
tourists in Africa, not simply because Nigeria has the largest
population in Africa but also because Nigeria has one of the poorest
health care facilities on the continent.
On top of the list of medical tourists from Nigeria are Presidents,
governors, legislators, company executives, and their family members.
Among the most notorious medical tourists are the late President Umaru
Yar’Adua and the incumbent President, Muhammadu Buhari. After repeated
medical visits to Germany, Yar’Adua spent three months in hospital in
Saudi Arabia, returning to Nigeria under the cover of darkness, never to
be seen in public until he was declared dead on May 5, 2010.
The record of his medical sojourn abroad has now been surpassed by
Buhari, who has already spent more than four months in London, receiving
medical treatment for an undisclosed illness, and his return date
remains undetermined. He says it is left to his doctors. It is this lack
of specificity about his return, more than the non-disclosure of his
ailment, that has generated the most criticisms, expressed in various
commentaries and protests.
Nigerian leaders are, however, not alone in the non-disclosure of
their illness nor are they the only African leaders who engage in
medical tourism. At least four other African leaders are co-travellers.
Jose Eduardo dos Santos, who has been President of Angola for the
last 38 years, had travelled several times to Spain for medical
treatment, again for an undisclosed problem.
Another sit-tight President, Robert Mugabe of Zimbabwe, who has
been in power since 1980, has made three medical trips to Singapore this
year alone. His political opponents have accused him of running the
country from his “hospital bed” but he says he is going nowhere and he
is not dying. He is 93 years old.
In the case of President Abdelaziz Bouteflika of Algeria, his
illness is difficult to hide, although its specific cause remains
undisclosed. He had a stroke in 2013, which transferred his mobility to a
wheelchair. But he has been going to France for medical treatment ever
before the stroke occurred, and he has been going there periodically
ever since for what his aides describe as medical checkups.
Even the relatively young President Patrice Talon of Benin
Republic, who is only 59, has also been engaging in medical tourism to
France. The major exception in his case, which his colleagues should
emulate, is the full disclosure of his ailments.
In June this year, his government disclosed that he went to a
hospital in France for two major operations, one on his prostate gland
and the other on his digestive system. The reactions of his fellow
citizens have been genuine prayers for his recovery.
Medical tourism by African leaders comes at a huge cost to their
countries, which the taxpayers have to bear. This explains the agitation
for more open disclosure not only of the nature of their illnesses but
also the cost of treatment. In the case of President Buhari, the
practice of non-disclosure is further complicated by the duration of his
treatment and the uncertainty that comes with it. As I once indicated
on this column, this has led to the loss of a human angle to the
criticisms as the public sympathy for his condition wanes.
Besides the capital flight that goes with medical tourism, the
practice is an indictment of the health care system in African
countries, most of which rank poorly on the Human Development Index. The
involvement of African leaders in medical tourism accentuates this
indictment by further undermining the health care system.
There are even bigger problems: One, political leaders may not have
the incentive and political will to improve the health care system at
home, if they and their families can go abroad for medical treatment.
Two, the deplorable situation in government medical facilities has
encouraged brain drain, leading African doctors to go abroad in search
of greener pastures. Today, there are Nigerian doctors in virtually
every notable hospital across the United States and Europe. Indeed, many
Nigerian patients go abroad for treatment, only to be attended to by a
Nigerian doctor or nurse.
For Nigerian doctors, who remain to establish their own hospitals
and clinics, the outcome has been pathetic. In Akure, Ondo State, for
example, a once notable medical landmark, Dairo and Dairo Hospital, had
to fold up after several years of operation. When I last interviewed Dr.
Tayo Dairo and his wife, Dr. Dupe Dairo, on why they closed down the
facility, their response was typical. In a country where nearly 70 per
cent of the population live below the poverty line, private hospitals
often have to run at a loss. The situation is worsened by medical
tourism as those who can afford to pay prefer to go abroad for
treatment.
The question now is what to do to improve the health care
facilities at home as no legislation can prevent those who can afford it
from going abroad for treatment. For one thing, legislators may not
make laws that would prevent them from going abroad for treatment.
Besides, the freedom to spend one’s money on medical treatment abroad
should not be curtailed by legislation.
One path to a solution is to impress it on federal and state
governments to increase the budgetary allocation for health care and
then set up enforcement committees at both levels to ensure that the
budgeted sums are released and spent as earmarked. The function of the
ministries of health should be limited to ensuring service delivery in
the various medical facilities.
Until and unless medical facilities at home improve significantly,
medical tourism will continue with all its negative implications for
health care system at home. Whether or not they are medical tourists
themselves, African leaders should muster the political will to improve
the heath care system in their respective countries.
Written by Punch Newspaper columnist, Niyi Akinnaso
When News Breaks Out, We Break In. (The 2014 Bloggies Finalist)
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