Combating Medical Tourism with Health Sector Investment

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Taoheed Dolapo Ajao

This piece is an attempt at a discourse on the Nigerian Public Health sector and the general problems facing heath care management with the singling out of one –- lack of good training schools for medical practitioners to access world class specialised medical education –- whose eventual overcome, has to be the irreducible minimum in the foundation for a solid heath sector. The problems facing the Nigerian health care management are myriad: from inadequate number of hospitals that provide standard medical services to lack of medication; from long queues in the available clinics to lack of functional surveillance system and routine medical intelligence during epidemics; from bad education of management specialists to unfulfilled dreams arising from corruption in the health sector; from lack of funding to ill-trained doctors and nurses, the list is endless!

Health care for the citizenry is one of the core social services that most governments worry about. Some governments prioritise it and try to democratise its access to the people while some others, particularly in the social democracies of the world, struggle to find a way to subsidise and make it affordable. While the degree of government’s involvement in health care still remains an ideological choice, incontrovertible evidence points to the fact that the abysmal level of health care services in sub-Saharan Africa makes it compelling for governments to intervene to boost the overall poor health indices of the people.

The criticality of the medical profession to society is underscored by the use of the parameter of life expectancy by the World Health Organisation, WHO, as a development index of the people. Before the discovery of modern medicine, life was fleeting and the environment was replete with a lot of diseases and medical challenges. The indispensability of the medical doctor is again highlighted in humanity’s desire to constantly push the boundaries of medical technology by modern medical research. Therefore, forming the substructure of the public health sector edifice, are medical doctors whose professional and ethical exertions on the health challenges of society, will forever remain invaluable. It is because of this that this piece has zeroed in on the abysmal statistical ratio of doctor to people and the alarming rate of attrition even among the unimpressive number of the trained local doctors. This is done with a view to highlighting the emergence of a local medical training university surrounded by state-of-the-art facilities that will start turning out highly trained doctors in a couple of years!
At the currently prescribed World Health Organisation (WHO) ratio of 1:600 (one doctor to every six hundred persons) as against Nigeria’s 1:4,000 (one doctor to every four thousand persons), it becomes compulsory to increase the number of medical doctors from its present 36,000 to the desired figure of 237,000 in order to meet the myriad challenges in the national health sector. Although many more medical doctors have been trained by the available medical schools in Nigeria, a lot of them have left for greener pastures due to lack of self-actualisation occasioned by inadequate job fulfillment within an unrewarding and unresponsive health sector.
Be that as it may, according to Mrs. Ogunsola, a lecturer at the College of Medicine, University of Lagos, “even if no doctor leaves Nigeria after being trained, it will still take us about 100 years to have the desired number of doctors we need going by the capacity of the available training schools!” Again, compounding the health situation in Nigeria has been the increase in the incidence of previously rare ailments and diseases requiring only advanced medical knowledge from institutions with specialised and intensive health education for their treatment and management.

The loss of confidence in domestic medical health care services –- itself, a combination of a Nigerian psychological complex for anything foreign and past government failures to properly reform the health sector at the secondary and tertiary health care levels –- has cost the nation very dearly on foreign medical trips yearly. The economic fallout from foreign medical tourism has been so enormous that from the 5000 people that travel out monthly to India and sundry countries, Nigeria loses $500 million annually with India alone, accounting for $260 million of the cash flight! .

These were the informing reasons for the Ondo State government in 2015, to establish the University of Medical Sciences in Laje, Ondo city, as a citadel of medical education to offer services of specialised facilities for medical training and research. In trying to make the university a complementing arm of medical education to an already established array of medical facilities in the area, it was expected that the further development of medicine would be served by the synergy of a mutually reinforcing relationship between the school and the surrounding medical facilities where the former uses its academic medical training and research to complement the latter’s virtually limitless possibilities in practical application.

Offering these virtually limitless possibilities in practical medical application, has been what is now referred to as the Laje Medical Complex in Ondo city; a veritable resort of local medical tourism, comprising the Gani Fawehinmi Diagnostic Centre; Mother & Child Hospital, one of the busiest maternity hospitals in Nigeria; the Accident & Emergency Services Hospital (Trauma Centre), accredited by the National Postgraduate Medical College in less than 3 years of operation for post graduate training in General Surgery, Orthopaedic Surgery and Radiology; the Call Centre and Kidney Care Centre, a state-of-the-art facility with just about the highest simultaneous functional capability for the most dialysis sessions in the country!

Situated in the centre of this Medical Complex is the University of Medical Sciences whose initial 5 programmes –- Medicine & Surgery, Dentistry, Physiotherapy, Nursing and Bachelor’s degrees in Anatomy, Physiology and the Physical Sciences –- will be supplemented by and enriched with Medical Laboratory Science this year 2017, while other courses will come later. Professor Friday Okonofua, FAS, the pioneer Vice Chancellor and renowned Obstetrician and Gynaecologist, hinted on the possible addition of Pharmacy and Herbal Medicine by the next academic year 2018. Expatiating further on this at the Media Stakeholders Meeting on Monday, 16th of October 2017, the Vice Chancellor talked about the possibility of harnessing the unique potentials of the medicinal powers of herbs and roots and the revolutionary application and academic standardisation of the acquired knowledge to provide an alternate and sometimes, complementing paradigm of cure to orthodox medicine. As a matter of fact, Professor Okonofua said due to the university’s suitable position to advance the cause of herbal medicine, the school has begun a multidisciplinary research into it and is expected to acquire herbal farms soon.

Expectedly, the first set of doctors and dentists will graduate in the year 2019. Not only has the University of Medical Sciences, Laje, Ondo, been accredited by the National Universities Commission and the Nigeria Medical Council, the school, as a result of the application of modern techniques in the teaching of medicine, has become virtually the first choice for students in medical education training curricula. The rash of academic strikes by lecturers and closure of schools normally endemic in the Nigerian university system have not hit the school probably because it is not yet a member of the Academic Staff Union of Nigeria Universities, ASUU, and again, because of the school’s leadership culture of accountability, transparency and consensual decision making.

Compared with other medical schools of even less facilities, the University of Medical Sciences’ school fees are surprisingly low. Since making enhancement of access to education at all tiers is part of the founding philosophy of the school by the Ondo State government in 2015, it should occasion no surprise that the school’s affordable fees had to be in harmony with government’s Caring Heart policy and the inherited progressive educational tenet of late Chief Awolowo. The school is proud to continue this legacy with the current administration and despite the prevailing cash crunch, it has been making judicious use of the unfailing subvention from the current Ondo State government.

An investment in good training schools for medical practitioners –- either by the government or private sector –- to increase the number of doctors and have the proper ratio of doctor to people and to acquaint medical personnel with the latest techniques in 21st-century medical technology will be a solid base upon which all other specialists in public/private health care management would be expected to build on.

–Ajao was Senior Special Assistant on Public Communication in the former administration of Dr. Olusegun Mimiko. He is now Executive Director of Milestone Communications