It’s a year now since the President Bola Ahmed Tinubu administration was inaugurated. Within the year, the government has endeavoured to institute policies in line with the United-Nations-related template for good governance. Specifically, the global template states that one of the targets of good governance is “effectively guaranteeing the right to health.”
In a 31 December, 2023 report in Nairametrics, titled “Top 5 health policies announced by federal government in 2023”, Chioma Chukwunedu, highlighted the following: Eye health takes centre stage (consisting of the national eye health plan, the Nigeria glaucoma guidelines and toolkit, and the national guidelines for screening and management of diabetic retinopathy); National Task Shifting and Task Sharing (NTSTS) policy to combat non-communicable diseases (involving the efficient utilisation of primary healthcare resources to reduce mortality rates from NCDs); Combatting cancer with strategic policies (consisting of the national strategic cancer control plan, the national cancer research agenda, the national strategic plan for the prevention of cancer of different forms; the national workplace policy on HIV/AIDS for Nigerian workplaces; and policies to reduce suicide and address mental conditions.
Meanwhile, on 12 December, 2023, the government signed a compact involving the Federal Government, State Governments and development partners on the Nigeria Health Sector Renewal Investment Initiative (NHSRII). The key goal of the initiative is to facilitate Universal Health Coverage (UHC). A State House press release of that date reported that President Tinubu said as follows at the occasion: “Delivering improved quality health is an underpinning factor in my promise of Renewed Hope to Nigerians. That hope is ignited here today with the support of all multilateral partners and agencies; health is back on the front burner.”
He was also reported to have said: “This occasion marks an opportunity for collective reflection and action as we recommit ourselves to the noble pursuit of health for all. The theme for this year ‘Health for All: Time for Action’ encapsulates the urgency and the determination with which we must approach this noble goal. Health is not merely the absence of disease but the embodiment of physical, mental, and social well-being. It is a fundamental human right and Nigeria’s commitment to achieving Universal Health Care Coverage is reflected in the unwavering dedication of my administration to uphold this right for every individual, young or old, in rural or urban areas.”
In his endorsement and goodwill message to the country, the Director-General of the World Health Organisation, Dr. Tedros Adhanom Ghebreyesus, said: “WHO is proud to join you in signing the health sector renewal compact and we remain committed to working with all of you on the road towards universal health coverage and a healthier, safer, more equitable and more prosperous future for all Nigerians. As the Yoruba proverb says, “Ilera l’oro.” (‘Health is wealth.’)
The 28 May, 2024 issue of Premium Times carried a report by Mariam Ileyemi, titled “Nigeria losing health professionals to countries that did not invest in their education – Minister.” The story has the note, “Over 5,000 Nigerian medical doctors migrated to the UK between 2015 and 2022.” In the report, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, was reported as making remarks at the opening plenary of the 77th World Health Assembly (WHA) in Geneva, Switzerland, from 27 May to 1 June, on the theme “All for Health, Health for All.” He was quoted as saying, with respect to Nigeria: “We are increasing domestic financing, expanding primary healthcare and financial protection for the poor and vulnerable, retraining frontline health workers and increasing training quotas for new ones, stimulating local production of commodities, reinforcing core public health capacities, strengthening prevention and preparedness, and controlling various disease outbreaks.”
In the light of the foregoing, it would be helpful to examine the public perception of healthcare in Nigeria, especially in the context of medical tourism. When the expression “medical tourism” has been mentioned in the not too distant past, it has been done in relation to travelling from Western countries such as the United States to non-Western countries such as India to seek high quality, faster and cost-effective healthcare. When the term has been used in relation to Nigeria, it has been in relation to seeking from foreign lands the quality of education that was supposedly not available in the country. In this regard, cost-effectiveness was never a consideration and relative time for accessing the healthcare was neither here nor there. This has placed foreign exchange pressure on the country, exacerbated brain drain and engendered increasing lack of confidence in the nation’s healthcare system.
As the government continues to introduce fundamental policies to enhance the quality of and accessibility to healthcare in the country, and as the private sector continues to engage in innovative investment in the sector, it would be interesting to find out whether Nigeria is finding space among the world’s destination for medical tourism. This exercise is particularly motivated by some medical experiences which some beneficiaries have been gracious enough to share with me in recent times. One of such experiences concerned a patient who had need for a very complex, high risk surgery recently. Normally, a number of local and foreign health facilities were considered for the medical intervention. After a critical review of the options, medical experts decided that the surgery should be carried out in Nigeria.
When the patient became stable after the apparently very successful operation, they were advised to go for an expert review of the procedures carried out and the level of success of the intervention. The choice of the country for the review was the United Kingdom. It was a highly-elated, more confident person who returned to Nigeria after they had been told, following the review by the UK experts, that there were no additional medical interventions needed, because the doctors who handled the health challenge had done a fantastic job.
Corroborating the declaration of a high degree of confidence in Nigerian doctors, a Lagos-based lawyer narrated this experience: “My client informed me of a close friend of hers, a high profile individual in Nigeria who had a severe medical condition. Several times, the friend had been to the United Kingdom for treatment. However, there was no improvement. He never, for once, consulted with Nigerians doctors here in Nigeria or even Nigerian doctors outside the country, as he had the mindset that non-Nigerian doctors, outside Nigeria, were the ones whose expertise could be assured. He was subsequently referred to the United States for further examination and treatment. On getting there, he was assigned a Nigerian doctor, and he expressed his displeasure, saying ‘I came all the way from Nigeria to the United States. Why am I being assigned a Nigerian doctor? If I wanted a Nigerian doctor, I would have stayed back in Nigeria. To his surprise, he was informed by the white doctors that the Nigerian doctor assigned to him was actually the best and that he, was in fact, the head of the department. He was amazed. Thereafter,
consultation was done, a date was scheduled for operation and the operation was carried out successfully; and his seemingly intractable problem was solved.”
Then just last week a Nigerian-American came to Nigeria for a complex dental surgery. He arrived the country on Saturday, 25 May, 2024, had the operation on Monday, 27 May and by Wednesday, 29 May, he was strong enough to tour some states, before returning to the US on 1 June, 2024. He has kept expressing his amazement about the medical attention he received in terms of the swiftness of the commencement of the medical procedure, the expertise displayed and painstaking care by the doctor who treated him, and the unimaginably low cost of the surgery.
Taking a broader look at the issue, a Lagos-based Medical Diagnostic Representive said: “With the establishment of several world class healthcare facilities in Nigeria, the country is set to become a veritable destination for medical tourism, in addition to reversing the brain drain in the health sector. These world class healthcare facilities springing up in Nigeria will also curb medical tourism abroad, conserve foreign reserves and create jobs. To mention just a few, there are the likes of Duchess International Hospital, Evercare Hospital, Cedarcrest Hospital, Marcelle Ruth Cancer Centre, Clinix Healthcare, complemented by facilities such as Echolab Radiology which offers a one-stop-shop to medical and diagnostic services. Their establishment is aimed at delivering the highest standards of healthcare, using the most advanced technology and treatments to provide Nigerians with the best medical expertise available anywhere in the world and serve as a dragnet for foreign medical tourists.”
To enhance this trend, he counseled: “The Federal Government needs to provide financial incentives to the private sector health establishments and increase opportunities for the kind of public private partnership that is already ongoing in states like Lagos where some renowned diagnostic outfits positioned within General Hospitals offer an array of laboratory testing at well-discounted costs. The essence of these financial interventions and projects in the critical healthcare sector is to fast-track the evolvement of world class healthcare facilities like the ones mentioned above. With that, the nation’s foreign reserves can be conserved, more foreign exchange can be made for the country, jobs can be created, brain drain can be reversed, and the country can become a destination for medical tourists and also ensure affordable and standard healthcare for Nigerians. The government therefore needs to deliberately encourage the private sector. Indeed, the best time in the history of Nigeria to offer itself as the best destination for Healthcare investment is now, and the opportunity should not be missed.”
This set of views are in consonance with the following admonition of the Director-General of WHO, Dr. Ghebreyesus, in his goodwill message to the unveiling of the NHSRII compact of 12 December, 2024: “As we always say, Universal Health Coverage is a political choice and it’s a choice you’re making. But it’s not a choice that’s made just on paper. It’s made in budget and policy decisions inside and outside the health sector. Most of all, it’s made by investing in Primary Health Care which is the most inclusive, equitable, cost-effective and efficient path to Universal Health coverage … investing in the people who deliver it, the health and care workers who are the backbone of every health system.”
The point is therefore that if healthcare is widely or generally available to the citizens and the quality is confidence-inspiring, the attraction of non-Nigerians whose patronage can, in turn, be of immense value to the nation’s healthcare system and foreign exchange profile can be induced. To achieve these noble goals, sharp policy focus, policy consistency and enabling action are essential. In the meantime, as a complement to the rather anecdotal evidence presented in this column today, it is important to avail the nation of more systematic and more concrete evidence of the comforting trend of medical tourism to Nigeria.
