Nigeria’s political elite stuck with country’s neglected healthcare system

…as medical tourism window vanishes over coronavirus

The room for medical trips abroad has disappeared due to the ravaging coronavirus pandemic, and the Nigerian political elite are stuck with the country’s poor health facilities that they have neglected over the years.

Successive Nigerian political leaders and their family members have made foreign medical trips their pastime while neglecting the country’s health sector.

Since coming to power in 2015, President Muhammadu Buhari has gone on several medical trips to various advanced countries, including the United Kingdom and Germany, in a brazen display of his lack of trust in the country’s healthcare system. In 2017 alone, Buhari spent more than five months receiving medical attention in foreign countries. Buhari spent 51 days in London early in 2017 (January 19-March 10) and another 103 days (May 7-August 19, 2017) on medical grounds, making a total of 154 days.

Late President Umar Musa Yar’Adua spent 109 days out of his 1,072 days as president in hospitals in Germany and Saudi Arabia.

Now Abba Kyari, Buhari’s chief of staff, and Bauchi State Governor Bala Mohammed have tested positive for the deadly coronavirus, but the window of medical tourism has closed on them, as it has for other members of the Nigerian elite who could afford the cost.

Most advanced countries where Nigeria’s political elite go for medical treatment are battling to control the spread of coronavirus and have, therefore, restricted visitors, leaving political leaders in Africa’s most populous country with no option but to put their fate in the country’s failed healthcare system.

Nigeria boasts some of the worst health indicators in the world occasioned by years of utter neglect by the ruling class. The country’s health system is bedevilled with a lot of challenges due to low budgetary allocation, poor infrastructure and low remuneration for medical staff, said Olusegun Ogunnibi, a consultant psychiatrist, public health physician and lecturer.

“Many of our facilities can’t boast of modern-day equipment like ventilators that can take care of an average of 50 patients. The best centre in Nigeria is at best in level two, and they are privately owned with our teaching hospital likened to mortuary, yet we are named as spending the most on healthcare treatment abroad,” Ogunnibi said.

Nigeria’s healthcare system ranked 187 out of 190 in the 2017 ranking by the World Health Organisation (WHO), only ahead of Democratic Republic of the Congo, Central African Republic and Myanmar.

In terms of funding, Nigeria’s budgetary allocation to its health sector that caters for some 200 million of its citizens has averaged 4 percent in the last five years. That amount in nominal terms is 15 times less than what Africa’s second largest economy, South Africa, spends in taking care of the health needs of its citizens, despite having a population that is nearly four times less.

Health expenditure as a percentage of the Gross Domestic Product (GDP) averaged 3.4 percent between 2007 and 2016, compared with South Africa (6.5 percent) and Kenya (4.5 percent), according to data sourced from the World Bank.

With nearly 20 percent of all global maternal deaths between 2005 and 2015, and no less than 900,000 maternal near-miss cases in the country, according to a WHO article published last year, Nigeria’s health system is unable to address what should be considered minor health issues, let alone major ones like kidney or heart transplant, cancer treatment etc.

The bed capacity of hospitals in Nigeria is half-a-bed for 1,000 people and there is less than one doctor for every 4,000 Nigerians.

According to BusinessDay investigation, 60-65 patients seek care at emergency units but only 20 patients are admitted with just 10 doctors available per shift.

Average life expectancy in Nigeria is 53 years compared to 62 years in South Africa and 80 in the UK, based on the latest available information from the World Bank.

Faced with gross-underfunding of the system, doctors in the country are seeking greener pastures abroad. No less than 5,405 Nigerian doctors are practising in the UK alone, according to Nigerian Medical Association (NMA) data, with over 4,000 doctors in the United States.

But it has not always been this bad, according to close watchers of events in the sector.

“In the 80s, we had some of the best facilities to the extent that people from other countries came to Nigeria for treatment, but all of a sudden, these facilities became dilapidated without repairs or replacement simply due to the lackadaisical attitude of the government since they can easily travel outside to get better treatment,” said Ade Alakija, a medical doctor at True Life Clinic in Victoria Island, Lagos.
“But now, because of the coronavirus, the government is bringing in the machines we have never had before to save lives because it affects them also. After this crisis, we hope they wake up and continue to look into the sector more so we can start seeing change,” Alakija said.

Nigerians spend over $1 billion annually on medical tourism as thousands travel abroad in search of the best treatment, according to official data. That’s at least N306bn a year (based on the previous 306/$ official rate) spent on medical care outside the country, an amount almost equal to the N359bn earmarked for the Federal Ministry of Health in 2020.

Global consulting firm, PricewaterhouseCoopers (PwC), noted in a report that patients who travel abroad for care are the same ones that can pay for the services at market prices in Nigeria and enable healthcare providers in the country to cross-subsidise those that cannot afford it.

But embarking on foreign medical trips is no longer on the cards for Nigeria’s elite as countries around the globe take drastic measures to containing the deadly pandemic that has infected over 207,000 persons and killed at least 10,000.

As the pandemic spreads, health experts say the outlook for Nigeria is gloomy. If the world’s strongest economies with some of the best health systems are being humbled and even overwhelmed by the ravaging coronavirus, Nigeria with its virtually poor health facilities would have a lesser chance of containing the spread of the virus if things get really bad, they say.

“COVID-19 is here and is going to get a lot worse in the coming weeks-months. Our neglected, broken-down healthcare system simply cannot handle what is headed our way. The numbers being published are a major under-estimation. We do not have the resources to test extensively,” said Adeyemi Johnson, interventionist cardiologist and CEO, First Cardiology Consultants.

Johnson said Nigeria is on the same trajectory as Italy, Spain and the US without the resources those countries have, projecting that thousands would die except there is a miracle.

“It is estimated that when the outbreak peaks in Nigeria, 4,000 ventilators will be needed. Currently, there are less than 200 in the country and none available to buy. The whole world is in short supply,” he said.
The experts say beyond winning the current battle to save people from dying of the virus, Nigeria’s political leaders must not fail to learn their lessons.

Doyin Odubanjo, chairman, Lagos chapter of the Association of Public Health Physicians of Nigeria (APHPN), said the government officials failed to understand there are illnesses that would even kill its victims before they have time to travel abroad for treatment.

“For some illnesses, you have to be treated within the first six hours to survive. Also, there are illnesses (like Ebola) that you may not even be accepted at all for treatment anywhere abroad. We need to educate our officials about these so that they see the imperative for developing our healthcare system in Nigeria even if you go abroad for treatment too,” Odubanjo told BusinessDay.

Ogbonnaya Igbokwe, head, Health Thematic Group, human capital policy commission at the Nigeria Economic Summit Group (NESG), said there is need for Nigerians to learn how to build, use and love their own hospitals.

“We must also as a matter of urgency equip them because there is a huge patronage of these foreign hospitals by Nigerians,” he said.


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