Posted By Damjan DeNoble
Last week I went out to hot pot with my fiancee and two friends, sisters, from Nigeria, one of who happened to be volunteering as a medical staff in a Nigerian private clinic. Over dinner, they described a chaotic private health care industry where hospitals often had no water at night, facilities saved money by turning off lights in the hallways, and pharmacy coffers were often empty due to a thriving black market. None of this was particularly surprising until they mentioned how much treatments there could cost; these hospitals were charging prices comparable to that of world class facilities in Europe and the United States, hundreds and thousands of dollars for simple procedures.
She also told me how Nigerians were mostly poor due to rampant political corruption, which had resulted in untold billions of dollars ending up in Swiss bank accounts. From her account, I got the impression that this type of money laundering was still going on. This part of our conversation also put the high health care costs into perspective; corruption is a viral disease, after all.
So, it was interesting to find an article in This Day, a publication that covers African affairs, about how the Nigerian House of Representatives “decried the culture of affluent Nigerians seeking medical services overseas.”
The House of Representatives has decried the culture of affluent Nigerians seeking medical services overseas. It said the trend was not only detrimental to the improvement of healthcare services locally but a drain on the nation’s scarce resources at this period of global economic recession.
It has therefore tasked the Federal Ministry of Health to set in motion all necessary machineries that would enhance the full implementation of the 2009 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 by the Nigerian elite.
Based on my conversation last week, and my past experience with African health care (I was in Botswana for two months in 2006 researching an ARV program there for what turned out to be an unfinished undergraduate thesis) I find two points of interest in this move by the Nigerian HoR.
1.) This is the first case of a country specifically decrying medical tourism as an economic threat to its own health industry. Many analysts have predicted that the global recession would precipitate in protectionist measures by many of the world’s developing and underdeveloped economies. Moreover, it has also been pointed out that affluent people in countries with large wealth gaps would also be targets of scorn and political backlash. The condemnation of Nigeria’s Elite by the Nigerian HoR is interesting in that it accomplishes both.
2.) If it wasn’t sad, it’d be funny how predictable a government of corrupt officials can be in times of economic crisis. Blaming ‘elites’ is not exactly a new tactic, is it? I just hope that a larger portion of the Nigerian people are able to see the utter absurdity of the government criticizing those Nigerians who can afford to escape the nightmarish, publicly administered and funded health care system of Nigeria for doing so: while at the same time, chastising them for not using a health care system, that purely through mistakes and irresponsibility of those in power is dangerous.
To top it off, the government makes little effort to hide the current, severe shortcomings of the health care system, instead opting for the ‘pie in the sky’ approach by paying lip service to the full implementation of the 2009 health care budget; “You must come back to Nigeria for health care, because by the end of 2009, there is a possibility that we will implement some of the most badly needed reforms that we have been promising for years.”
We’ll try to keep a running tally of developments involving further health industry protectionism.
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“Yea, health care in Nigeria is super expensive. The only way to protect from medical tourism is to improve the quality of the hospitals. This would mean paying the doctors and nurses competitive salaries. That would mean diverting funds from the public sector, since most hospitals are state-owned. All this would mean that Nigeria has to increase accountability and reduce corruption. Maybe one day that would happen.
And maybe one day, pigs would fly
”
Saratu,
Any insights as to why the care is so expensive?
//D
Well, in my estimation, I think that the reason health care is so expensive is that the many general hospitals are linked with universities. Many of the prestigious unis in most West African countries, be it Ghana or Nigeria or Senegal or wherever, are federal or state-owned, meaning that all their endowment comes from these government institutions. With corruption, these monies that are meant to be directed (That is, in the event that they were initially meant to be directed) to these hospitals and universities never reach them. That means necessary equipment does not get to the hospitals, people don’t get paid well enough or as well as they should be, medical schools don’t get well paid as well so students are not up-to-date on their equipment, etc, etc. There are a lot of private hospitals in Lagos, particularly, but I’m sure in a lot of major Nigerian cities, I’m sure. But I think it is fair to say that unless its a very well-funded specialist hospital (There’s only 1 heart specialist hosp in Lagos, I can tell you and it’s in the richest part of town) not many private hands can afford the major medical technologies that can save lives.
I think another thing is the issue of trust. Most Nigerians don’t trust anything Nigerian. I know I can’t. Even the most basic things like fruit juice, you would find people buying exports when they can afford it. It’s a mixture of trust issues and collective inferiority complex, I think. And even when the stuff made in Nigeria is quite good, there is the expectation that it would deteriorate in quality as time goes on. Sadly, it often does. There was a type of soda called Lacasera that I used to love in high school, but as time went on, cost of production increased and the quality of the product went down with it. It was discontinued for awhile (I think it’s back in production now, several years later) but it’s exemplary of what usually happens.
And since a lot of Nigerians go abroad anyway to see family members they go to the hospital as well while they’re over there. That, I think, could also be because of the lack of equipment thing in some hospitals. My family doctor always tells us that there are only a handful of Nigerian doctors he can trust with his own health. All those doctors are in their 70s like he is except one, who also works at his small private practice, who is about 50. Kind of makes you think, huh?
S.
I had not read that article from This Day, but I believe it adds a very interesting edge to this entire sordid affair. You made some good observations, especially concerning the nonchalancy of the Government towards its own inadequacy. ” the government makes little effort to hide the current, severe shortcomings of the health care system…” As Saratu pointed out, the Government would have to increase its accountabilty to better anything in the country and that would mean putting themselves and their bank accounts under a microscope. One must not forget that a good number of the Nigerian HoR are among the so called “Elites” that go abroad for their own health care. As with so many other things that involve the Nigerian Government, this is all talk with none of the promised action. A full implementation of the 2009 health budget? HA! As if that would EVER happen.
By the way, I wonder exactly what this budget is. If we can budget 3% just for the salaries of our oh-so-wonderful leaders, how much shall the healthcare budget for 140 million nigerians come to?
p.s – you did a good job Damjan.
The first part of your response sounds a lot like what we see in China and Vietnam – Hospitals don’t charge very high prices out of malice and greed, but rather out of a need to pay the salaries of their people, and to keep the institutions running.
Interesting point I had not considered about the government ministers being elites themselves. I now have a funny image of several ministers yelling at a mirror, telling themselves what bad bad people they are.
Hi,
I think the issue of medical tourism is an unfortunate development. Our leaders (and the followers) have to understand the damage this trend will do to the long term viability of our economy. However, it is a difficult thing to legislate against. If people have money and they need the service, they will find way to get it. I think the solution lies around private investment in health care industry in Nigeria. I hope that people with money both local and foreign will invest in the health care industry just like they have and still are investing in the Telecom, Oil and Gas industry. If we have 1/10 of the investment in these industry towards the broader health care industry, the need to travel abroad will become a non-issue.
Certainly a part of the solution may lie in a healthy private health care system. But all countries, even the most affluent ones (The current crisis in the American health care system being case in point) must also have strong public health infrastructure that is accessible to all of its inhabitants. This is where legislation has a big hand to play.
As for medical tourism, I agree with you that in some ways it is an unfortunate development for some countries because it may provide an avenue for its most well to do folks to go abroad for care, and thereby neglect to help improve the health care system in their own country. This is certainly an aspect of medical tourism that I had not thought about much before, and know of few people who have…will have to look into it more going forward.
Posted by Graham Orodje CEO, Taurus Mobile Services Limited on Linked In, April 2, 2009
(http://www.taurusmobile.com/)
From a commercial perspective there is enormous potential in the health sector in Nigeria for private investors. Unfortunately as with other key sectors in Nigeria, initial investments are usually made by foreign investors. Nigerian investors only seem to get involved or interested once they see the success of the foreign investment. The telecoms, oil and gas industry are prime examples of this. A key reason I suspect the Nigerian government don’t seem as committed as they should be to the health sector is that the potential returns and value may not always be financial and they tend to judge every sector largely on potential financial returns, something the health sector may not be able to provide. The human aspect is not a factor they give enough thought to because they and their families can afford to get treatment outside the country. A part of the reason for the high cost of treatment may be because many Nigerians tend to self medicate and private hospitals like other businesses need to achieve a return on investment and if there aren’t enough patients then they need to charge more for those that do visit their hospitals.
@ Graham
Great thought on the effect that the lack of potential financial returns may have on politicians’ commitments to the health industry.
While it is hard to comment on the cause and effect relationship leading to price gauging, your comment regarding self medication seems like a resonable contributor. Another commentor also suggested that the lack of oversight leads to a lot of funds earmarked for the healthcare system to end up in individuals’ pockets and not the hospitals. So, hospitals are forced to charge high rates to those who can afford it (and many times to those who can’t) in an effort to survive financially.
I am setting a medical tourism company in Nigeria called HealthImpact. It was borne out of the joy experienced from the services of such organisation in saving my brothers life from the shoddy management of my brothers health in Nigeria. The rich falls sick, the poor falls sick the more in Nigeria. Government pays lip services to healthcare in the country. The ones that are available are far too expensive and even if one affords it, he gets poor result at the end. In all of all these, saving life and knowing what to do ,where to go, when to go for answers in a health challenge issues need not be politicized.
dear austine,
i am a cardiologist with National heart institute new delhi.Many people come to us from nigeria for treatment of heart disease to us and i could share their pain and difficulties.we want to help them furthur. would you please help us .kindly write me.
PP
Great going Austine! All the best in your new venture. We are already into this business and can create synergy with you for fruitful results.
Feel free to contact:
Dear Austin;
I am the National Manager for Fortis Healthcare ltd, a chain or 52 corporate hospitals in India. I am based in in Abuja. If you are inserted in setting up a medical tourism company then we would like to sign you as our authorized facilitator with attractive referral fee.
If interested please contact me at
or call me +234-81-6756-1113.
Thanks;
Sudhir S Rathore
National Manager
Fortis Healthcare ltd.
Abuja
Dear Sudhir,
I am writing my research proposal on medical Tourism in Nigeria: a case study of Osun State. please if you can help with any relevant information . I live in London.
Rgds
Your observations and comments are interesting. We are talking here about leaders that are lost in greed to improve health services. Going abroad for treatment is a killer to Nigerian economy and creating poverty due to lack of job creation. It is a pity that if we refuse to value and improve on what we have, our dependency will last longer. the budgets never use for the purpose neither are any to probe this. The private Hospitals target profits as usual and what is the disposable income for an average Nigerian except theELITES; our so call leaders need to be critical in their thinking and serve their nation not their pockets; before Nigeria can attract tourists for medical treatments. ”I wish Nigerian leaders can see treating themselve in their own country as a pride”
Nigeria and India have been collaborating in the medical R&D and healthcare front. Trade between Nigeria and countries like India has improved in the last few years. India has increased metal imports, whereas Nigeria is making use of affordable healthcare in India. More bilateral trade will be a boost both economies. But in the long term the govt should promote better healthcare infrastructure within the country. Source: India medical tourism