From Brain Drain to Medical Tourism

04 Oct 2012

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Jonathan, Chukwu and elumelu

Adeola Akinremi writes on challenges of post-independence healthcare service delivery in Nigeria

President Goodluck Jonathan is disappointed in himself. He may not say so publically, but the shambolic health sector he inherited is just as comatose as it was when he was elected. He had hoped to stop the brain drain in the health sector. He also promised improved healthcare delivery as a major priority. None of these has happened.

Of the many things that now trouble his mind is the medical tourism that continues to expose a weakened and inefficient healthcare system in Nigeria. Privately, he tells his friends how healthcare is failing Nigerians. For instance, hospital data obtained from the Abuja General Hospital showed that a large portion of maternal deaths is attributed to women who gave birth at home without access to the healthcare.  Add to this, the throngs of Nigerians seeking medical help abroad.

Early this month, the president’s wife Mrs. Patience Jonathan was flown to Wiesbaden, Germany where she is recovering from an undisclosed ailment in Horst Schmidt Klinik, the same hospital, used by Jonathan’s predecessor, late president, Umaru Yar’Adua. This year alone, Nigeria recorded the death of many dignitaries who died receiving treatment abroad.

That a very famous Nigerian, Ikemba Nnewi, Odumegwu Ojukwu died in foreign hospital in London and the news from India the other day that Chief Edwin Ume Ezeoke, former speaker of the House of Representatives, died in an India hospital for obvious lack of quality medical institutions in Nigeria, is at least enough to cause president Jonathan sleepless nights. And now, what with his wife also out of the country on what is now part of the local lexicon, only known to Nigerians as medical tourism.
Expectedly, Mr. President is deeply worried that at 52 years, Nigeria’s health sector reform continues to be a mirage or at best a journey on a famished road. This he has acknowledged on his official website, stating: “The current state of our health system is quite worrisome.” But Jonathan’s admittance perhaps is only stating the obvious. He is not the man with more worries than the masses of Nigerians who cannot afford or access quality healthcare services.

The late former Minister for Health and Human Services, Professor Olikoye Ransome Kuti captured it all in one breadth on March 19, 1998, while addressing a group of foreigners and Nigerians in Kaduna.  He said, “Nigeria will never be able to care for its people until it has an effective health service system.” But the country has remained in doldrums twelve years after.

A review of healthcare development in Nigeria shows that the country’s 10-year plan for development and welfare (1946-56) was the first attempt at planning for Health Services in Nigeria. But since October 1, 1960, successive Nigerian governments (civilian and military) have come up with the 2nd, 3rd and 4th National Development Plans, all of which had substantial portions dedicated to addressing issues related to national health care systems.
The late Ransome-kuti, the man who pioneered primary healthcare services in Nigeria may have died but his insight into the trouble with Nigeria’s healthcare may provide an escape for President Jonathan and relieve him from his worries, if thoughts and actions are implemented with the required commitment and funding.

According to Ransome-Kuti, at the beginning of the oil boom, General Yakubu Gowon announced the programme for health, allocating $1.7 billion over five years.  With the assistance of the World Health Organisation (WHO), a National Health Implementation Plan was produced for a healthcare system based on primary healthcare. This plan was never taken to the Executive Council for approval by the Federal Ministry of Health (FMOH), and so it never became an official document for action.

Indeed, for Nigerians, this is not a normal time. Improvement in healthcare services across the country is of major concern, as Federal Medical Centres and teaching hospitals remain ill-equipped, under-staffed and under-funded. The increased burden of preventable diseases such as polio, malaria, cholera and heart- related diseases that have now over-stretched Nigeria’s healthcare facilities, and lack of improvement in medical services is forcing more and more Nigerians, who can afford it, to seek better healthcare services abroad. 

According to a 2012 BGL report on Nigeria healthcare system, infrastructure decay, brain drain, incessant workers’ strikes and low investment in the sector characterise healthcare services in Nigeria. Collectively, all tiers of the healthcare system have suffered. In 2011, national spending on teaching hospitals and federal medical centres was estimated at N204 billion, approximately 79% of the government’s health expenditure. However, only N20.25 billion (10 percent of total hospital expenditure) was allotted to capital expenditure in spite of insufficient medical equipment.

In the BGL report, the Federal Ministry of Health alluded to the fact that, the human development indices for Nigeria were among the worst in the world. Nigeria shoulders 10 per cent of the global disease burden and is making slow progress towards achieveing the 2015 targest for the MDGs on healthcare.
Instructively, healthcare delivery indices in Nigeria have largely remained below country targets and internationally-set benchmarks due to weaknesses inherent in the system. Hence the government is convinced that a purposeful reform of the National healthcare delivery is necessary. The government, thus, initiated a process that led to the development of the National Strategic Health Development plan 2011-2015(NSHIP), which was developed in 2010.

Yet, the national strategic plan, which hopes to strengthen the national health system and to vastly improve the health status of Nigerians, estimates that a total amount of N3.99 trillion (US$26.6 billion) would be required to reposition the Nigerian health system over the next six years. But that has not taken off.

This plan was also delivered in August 2010, which was already eight months into its first implementation year. That already puts the plan on a shaky start and has cast doubts on it ability deliver as intended just like the previous years.

Just the same, the National Health Insurance Scheme (NHIS) conceived to provide medical coverage for users under the scheme has only have 5 million enrolled. The NHIS has equally remained primarily an urban thing, a clear departure from its objective, which was to make healthcare accessible and affordable primary for all Nigerians. Experts say the lack of clear policy direction in healthcare delivery has hindered its expected progress.

But the Chief Medical Director at Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun has a different view on the matter. According to Osibogun, “Nigeria has a national healthcare policy that has been reviewed over time that can adequately provide direction for our healthcare delivery. The main challenge does not also stop at the inadequacy of our healthcare system but the lifestyle of the people.”

Osibogun insisted medical tourism is a global phenomenon, stating that there are several reasons why people all over the world leave their countries for medical assistance abroad. “Medical tourism is a global phenomenon. People travel from United States to Cuba for medical assistance too. It is the human spirit, which is adventurous. People go on medical tourism for issues of privacy and preference.” He talked about perception too.

But, the situation is unacceptable such that the Tony Elumelu led Ministerial Committee on the Private Sector Healthcare Initiative said it hoped to tackle effectively with strategies, and a road map, for the unlocking of private sector entrepreneurship in Nigeria’s health sector. The goals is to have at least one world-class private sector hospital in each geo-political zone, in order to drastically reduce the exodus amongst healthcare professionals and citizens and curtail the capital flight through medical tourism. 

In the end, if the Elumelu-led committee walk the talk, President Jonathan might achieve his goal of creating a Mecca for medical tourists in sub-Saharan Africa under an initiative expected to change healthcare service delivery in Nigeria.

Tags: Health and Wellbeing, Health, Medical Tourism

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