Medical Tourism: A Drain on Nigerian Economy

It has now become commonplace for Nigerians who can afford it especially public officials in Nigeria to seek medical care abroad even for ailments that could be handled at home. It is said that Nigerians spend about $500m (N78bn) yearly for medical treatment abroad. The most popular destinations are India, Germany, the UK, and the United States. This is despite the fact that Nigeria has many trained medical practitioners and numerous medical centres. YEMI OLAKITAN examines the reasons for this medical exodus abroad and what could be done to address it.

 

Health is wealth so the saying goes, which is why people go to great lengths to ensure proper medical care for sundry ailments. However, the rising spate of chronic illnesses such as cancer, renal failure and cardiovascular diseases has raised the demand for specialist and sophisticated medical care, which is in short supply in Nigeria. Even though some of the nation’s tertiary institutions still have requisite personnel and equipment to manage chronic cases, many Nigerian prefer to fly abroad to treat both chronic and not-so-chronic conditions believing that the level of care available in-country is not up to scratch.

 

Indeed, people fly to London for mere check medical ups and common colds and many even end up in the hands of Nigerian doctors in the United States, where about 20,000 Nigerian are estimated to be practicing medicine and in other countries such as the UK and Saudi Arabia.

 

Expectedly, the overall bill is high since this come in dollars, a situation that has not gone down well with Nigerian doctors, who wonder why people are ready to pay so much abroad while they often hold the short end of the stick at home often going on strike to get decent wages and allowances. Private clinics hardly fare better with many struggling to cope with patients’ debts and unremitted fees from Healthcare Maintenance Organisations, which is threatening the entire National Health Insurance Scheme.

 

Most worrisome if the fact that public officials in middle to senior cadre travel aboard at the drop of a hat for medical care and the bills are picked by the government, which is accused of failing to properly address the needs of the health sector in terms of staffing, equipment and facilities.

 

Some of the high-profile cases of top government officials and family members seeking medical treatment abroad including late President Umaru Yar’Adua, First lady Patience Jonathan, prominent, state governors and ministers drive home the point most poignantly.

 

The Nigerian Medical Association, NMA, estimates that Nigerians spend over N120bn annually, on medical tourism while about 5,000 patients travel to India monthly for treatment in line which a rising phenomenon called medical tourism.

 

Medical tourism’ is originally a term used to qualify a patient’s movement from highly developed nations to other areas of the world to get medical treatment, usually at a lower cost.

 

More recently, however, the term is being generally used to mean every form of travel from one country to another in search of medical help, which can also simply be called ‘medical travel’. It also includes travelling to countries where treatments for particular conditions are better understood.

 NMA President, Dr Osahon Enabulele, says the organisation had been encouraging public office holders to patronise Nigerian hospitals rather than going overseas for minor ailments that could be handled locally. In fact, things have gone so bad in the country that Nigerians travel abroad to conduct medical check-ups on simple matters such as blood pressure, he said.

 According to the NMA, Nigeria has the resources and manpower to tackle most ailments ravaging citizens within the country.

 

It says the country is suffering in the midst of plenty and needs laws to address issues of medical tourism. A medical board that would screen public office holders to ascertain their eligibility for medical treatment abroad is necessary particularly where public funds are involved.

 

The association warns about the staggering amount of money Nigeria is losing to foreign countries (especially India) on medical tourism.

 

According to reports, U.S and Great Britain used to have greater share of Nigerians seeking foreign healthcare; Indian has outperformed these countries in recent years. It is estimated that 95 per cent of Nigerians traveling abroad for medical treatment go to India.

 

The NMA said India rakes in well over N40bn, which is about 50 per cent of the bill. (Over 5000 Nigerians travel to India, with each of them spending between $20,000 and $40,000 on average a year.) India was also projected to have raked in a whopping $2bn from global medical tourism valued at $20billion a year.

 

Reports reveal that the phenomenon called medical tourism is not limited to Nigeria alone. It is a subject of global concern. This is because many surgical procedures performed in medical tourism destinations cost a fraction of the price they do in the Europe of the US

 

Investigations reveal that a liver transplant that costs $300,000 in America costs about $91,000 in Taiwan. Another problem is that countries that operate public health-care systems often have long wait times for certain operations. In Canada, for an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. This prompted Canada to set waiting-time benchmarks, such as 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures. This is one of the reasons why people seek medical care abroad.

 

Medical tourists come from a variety of locations including Europe, the Middle East, Japan, the United States, and Canada. Factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

 

In countries, like the United States, medical tourism has large growth prospects and potentially destabilising implications. It is projected that medical tourism originating in the US could jump by a factor of 10 over the next decade.

 

An estimated 750,000 Americans went abroad for health care in 2007, and a report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.  Popular medical travel worldwide destinations include Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States.

 

Investigations reveal that India is placed among the top three medical tourism destinations in Asia, mainly due to the low cost of treatment, quality healthcare infrastructure and availability of highly-skilled doctors.

 

In Nigeria, India has become the doyen of medical tourism and the preferred location. India, Thailand and Singapore are the three countries that receive maximum medical tourists owing to the low cost of treatment, quality healthcare infrastructure, and availability of highly-skilled doctors within Asia itself.

 

Why have Nigeria chosen India over other countries of the world? It is said that in Indian, medical tourism is one of the largest sectors and is poised to grow at an annual rate of 15 per cent to reach about $158.2 billion by 2017. India and other Asian countries have introduced various marketing strategies to attract medical tourists, and they have succeeded immensely and Nigeria is just one of the countries going there.

 

Patients are attracted to low priced treatment options, availability of variety of treatments, improved infrastructure in terms of healthcare facilities and attractive locations for spending time after treatment.

 

A nation such as Thailand positions itself as a dual purpose destination for both medical and economic holiday with attractive locations; Singapore promotes itself as a destination for fine quality in medical treatment. India is known mostly for its cost-effective medical treatments along with high standards in cardiology, orthopedics, nephrology, oncology and neuro-surgery.

 

Another reason why Indian is reportedly a popular destination for medical tourists is that she is known for its alternative treatment options such as yoga and ayurveda. India’s medical travel industry is clipping along at a 30 per cent growth rate annually. India welcomes most of its cross-border travelers from the immediate region (e.g. Bangladesh, the Middle East and Africa). However, some of those gains have arisen from increasing numbers of Americans, Canadians, and Europeans seeking treatment, particularly the more expensive cardiac and orthopedic surgeries, for which health travelers can save tens of thousands of dollars compared to the cost of treatment at home.

 

India’s official national health policy encourages medical travel as part of its economy’s “export” activities, although the services are performed within India. The government uses revenues generated from medical travel to increase its holdings in foreign currency. With government and corporate investment solidly behind its healthcare system, more international hospitals and super-specialty centers are opening every year.

 

Heart care has become a specialty in India, with centers such as Fortis Wockhardt (Mumbai) and Apollo (New Delhi and Chennai) leading the way. Success and morbidity rates are on par with those found in the US and Europe, with major surgeries at up to 15 per cent of the cost.

 

Factors that have led to the increasing popularity of medical travel include the high cost of health care, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad.

 

Biodun Ogungbo, a consultant neurosurgeon, said there are huge risks for Nigerians in medical tourism. There are dangers in going to places such as India, South Africa, United Kingdom and Egypt for medical treatment, without proper information about the doctors working there, their qualifications and experience.

 

“Many patients and their relatives have no clue about the doctors treating them and whether they are truly qualified to carry out the prescribed treatment. A few patients have returned from these countries with much more than they bargained for. Some have had the wrong operation, unnecessary procedures and treatments and others have significant, lingering and life-long complications. Some hospitals also perform totally useless and experimental procedures on patients at huge costs”, he said.

 

“When the treatments have gone well, who will continue the necessary follow-up care here in Nigeria? When you receive treatment in a foreign country; it becomes expensive to travel back for follow up in order to consult with whoever provided you with primary care. When you shop around for a hospital in Nigeria, you can easily visit them in person and meet with the staff.  But, this type of in-person inspection becomes harder if the hospital is in another country. These hospitals are not vetted by the Nigerian Medical Association, NMA, the Health Ministries or the Medical and Dental Council of Nigeria, MDCN, so you don’t know what you are involved in. We do have good hospitals here and doctors who are credible and well trained.’’

 

Chief Medical Director, the Lagos State University Teaching Hospital, LASUTH, Ikeja, Prof. Olawale Oke, said some of these treatments can be obtained in Nigeria.  According to him, some Nigerians who seek medical help abroad die in the process based on wrong diagnosis and treatment.  “Anyone who goes on medical tourism should be sure of where they are going to because some of the ailments they go for can be treated here. They could fall into wrong hands”, he said.

 

Investigations by Sunday Mirror reveal that, medical tourism is facilitated through companies who openly advertise here in Nigeria while Nigerian hospitals and doctors are not allowed to advertise. Yet, many of these hospitals and businesses in India, Egypt and South Africa do not subscribe to the same ideals and openly advertise their services in Nigeria.

 

This development has prompted the Federal Government through the Minister of state for Health, Alhaji Suleiman Bello to issue a statement saying, the “Federal Government will no longer be interested in funding medical trips for its officials abroad. President Jonathan said the funds used for such trips have led to loss of the nation’s scarce resources.’’

 

The House of Representatives also decried the culture of affluent Nigerians seeking medical services overseas. It says the trend was detrimental to the improvement of health care services locally and a drain on the nation’s scarce resources. It therefore tasked the Federal Ministry of Health to set in motion all necessary machineries that would enhance the full implementation of the budget in the health sector so as to elevate the quality of medical services available in the local health institutions and discourage what has now become medical tourism.

 

Sunday Mirror investigations reveal that even poor Nigerians seek treatment abroad. There have been cases of poor and sick people campaigning for funds to travel abroad to secure medical care for ailments that could be treated in Nigeria.

 

There are also cases for which the Nigerian medical system is incapable of treating- or is believed to be incapable of treating, due to lack of standard equipments or perceived lack of qualified and experienced personnel.

 

Popular music producer, Babatunde Okungbuwa aka OJB Jezreel, had a kidney transplant in India although he was not a government official or political office holder. He could not afford to go but well meaning Nigerians picked up the bill. He was quoted to have quarreled with the expression, medical tourism, saying “How can a life-saving trip be compared in any way to tourism! Really, trips like this are motivated by lack of medical commitment ?to saving lives and poor facilities in our country,” he said.

 

Indian national policy continued to be directed at positioning the country as a medical destination of choice in global medical/health care delivery. India is achieving this because of the competitive costs, seamless facilitation through pre-diagnostics in Nigeria itself and smoother visa issuance procedure, wide choice of good hospitals and the better patient-doctor interface leading to higher mutual comfort and trust.

 

Mr. Babatunde Adisa, a Lagos businessman who spoke to Sunday Mirror on the subject said, ‘‘Medical tourism is a global issue. It is not just a Nigeria problem alone. The world is fast becoming a global village and we must sink or rise to compete favourably with rest of the world, not only in medicine but in other sectors. There is no reason why Nigeria cannot and should not achieve what India has achieved. They are not better economically. These things are simply based on preferred priorities. If Nigeria decides to position herself as a medical center of choice for the global community and invest in that sector, the world will come to us. We have the resources, instead of lamenting we should simply go to the drawing board”.

 

Reports reveal that there is a National Health Bill on the floor of the National Assembly that seeks to curb medical tourism although some have argued that patients are free to seek medical care from wherever and whoever they deem fit, and with the globalization of the world, things are continually changing and the options for where to seek care from are increasing. It will not be right to force people to get treatment from where they have no confidence.

 

Another problem affecting the medical sector in Nigeria is that Nigerian doctors and hospitals are not allowed to advertise while their counterparts abroad advertise regularly on the internet and other media platforms.

 

Reports reveal that physicians were once not allowed to advertise by the American Medical Association, AMA. This situation has changed after the AMA was sued by doctors and the US Supreme Court declared that it was an unfair restriction. The Court ruled that it was also unfair to patients, who need access to information on doctors, so they can select the best for themselves.

 

Several other countries have also followed the pattern of regulated advertisements and have made information about their services and professionals available to the world, attracting seekers of medical care worldwide including Nigerians.

 

By allowing this kind of outdated policies to continue, Nigerians limit the growth of medical care in the country and build up those of other countries.

 

Ola Ayodeji, a kidney specialist with the Peninsula Kidney Associates in Hampton, Virginia while speaking on whether banning overseas medical treatment for senior government officials would help improve Nigeria’s health system, said, “I would not advocate restricting access to highly needed care, because when you have a medical problem, it becomes a personal thing, you want to survive, whatever it takes, wherever you can get the care, whatever you have to pay”.

 

However, some experts see the need to encourage private sector investments in the medical sector as most of the hospitals being patronised abroad are in any case privately-owned facilities.

 

Chairman Life Bridge Medical and Diagnostic Centre, Senator Ikechukwu Godson Abana, said, high import duties, multiple taxations and exorbitant fees by various government agencies are responsible for low patronage of private investment in Medicare in Nigeria.

 

He noted that the various taxes are often transferred into the costs of providing services to Nigerians. The reason why Nigeria loses huge sums in capital flight to medical tourism is because of citizens’ lack of confidence as Nigerians often complain that most of the nation’s hospitals lack the modern equipment needed for effective diagnosis and treatment.

 

It appears however that government is waking up to this reality.

 

President Goodluck Jonathan, whose wife had made some medical trips to Germany in recent years, had recently expressed his determination to curb medical tourism by involving private investors in the health sector reforms.

 

The president made the declaration during the inauguration of the Nigeria-Turkish Nizamiye Hospital in Abuja.  The president said that the state-of-the-art hospital demonstrated a pragmatic response to the government’s policy aimed at enhancing private-sector participation in healthcare delivery in Nigeria.

 

A lot of Nigerians go out almost on a daily basis to seek medical help abroad and almost all the hospitals that attend to them outside this country are privately owned.  If we encourage the private sector to take the lead; that would save the amount of money Nigerians pay outside.  The determination of our government is to ensure that our citizens have access to quality and affordable healthcare services. In this regard, the role of the private sector in complementing government efforts is very crucial. private-sector initiatives such as this hospital will aid the government's efforts to halt the enormous capital flight arising from increased medical tourism and the avoidable stress experienced by Nigerians, he had said.

 

The president said that the Federal Government had constituted a committee to develop a network of improved modern healthcare infrastructure to further stimulate investments in the health sector.  Jonathan stressed that a number of world-class diagnostic and treatment facilities were being developed in Abuja, Lagos and other locations across the country.

 

Dr Mustafa Ahsen, the hospital’s Medical Director, said that the hospital offered Nigerians the opportunity of staying in their country and receiving world-class medical treatment which they hitherto sought abroad.

 

According to him, the hospital aims to encourage Nigerians to receive medical treatment in Nigeria where their friends and relatives are readily available.

 

The crux of the hospital's operational mode centred on the treatment of patients with compassion, respect and the utmost care, we will never lose our compassion and concern; we will never fall into the wrong delusion of viewing our patients as file numbers.  We want to approach people who are suffering, distressed, frightened and on the verge of despair with empathy to end their pain.  Our goal is to be a friend to someone who seeks a friend and a symbol of hope to the needy, he added.

 

Observers stress that Nigeria is blessed with a lot of qualified, seasoned and proficient medical personnel, and doctors, who can manage any medical condition or disease. However, serious improvements in the state of Nigerian hospitals in terms of equipment and funding will go a long way in curtailing medical tourism.

 

A veteran nurse and midwife, Mrs Olayinka Adeyemo, who spoke with Sunday Mirror on the subject, said, Nigeria must, first of all, solve the problem of electricity. “This is a major problem in medical practice. A private hospital in Nigeria that is running on diesel on a daily basis cannot perform a surgical operation at the same cost as an Indian hospital would. It will be cheaper. Our epileptic power supply is a major obstacle to curbing medical tourism”, she stressed.