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Medical Tourism Vs Poor Health System ~ By Constance Meju

It is no news that Nigerians now seek healthcare outside because the quality of service available in the country is pathetic. What is however not general knowledge is the cost implication of this new trend. President Muhammadu Buhari, himself a culprit, recently put a figure to this. He said oversea treatment removes from the country, a staggering sum of N400 billion annually/

Represented by Simon Lalong, Plateau State governor, Buhari said at the inauguration of senior executive course (SEC) 41 of the National Institute of Policy and Strategic Studies (NIPS), Kuru, Jos, that the country loses about N400 billion annually to medical tourism. That means that in the first four years of his administration, Nigeria lost N1.6 trillion to other countries as medical tourism.

The author, Constance Meju

Theme of the event was, “Funding Universal Healthcare Delivery in Nigeria”. The president said the country was losing so much to medical tourism because of the health sector’s “inability to combat deadly diseases and mass migration of medical personnel out of the country”.

According to him, “Government has shown strong commitment to the revitalization of the health sector. These efforts notwithstanding, our health sector is still characterized by low response to the public health emergencies, inability to combat outbreak of deadly diseases and mass migration of medical personnel out of the country.

“This has resulted in increasing medical tourism by Nigerians in which Nigeria loses N400n on annual basis”.

The president said his administration was targeting 10,000 functional primary healthcare facilities across the country. However, the needs in the sector cut across primary, secondary and tertiary health sectors.

In 2017 the president spent 150 days in the UK treating an undisclosed ailment which cost is still shrouded in secrecy and he has repeatedly been accessing medical care outside the country. As first citizen, the onus of establishing standard health services that will preserve lives rests on him but even the health facility within his household is not up to billing.

The House of Representatives resolved in 2017, to investigate the deplorable condition of the State House Clinic in Aso Rock following its inability to deliver basic medical services.

The investigation was to cover how the clinic utilized the N10.98 billion budgeted for its operations from 2015 to 2017. According to a Punch publication, the clinic received budgetary allocation in excess of N3billion in each of the years, 2015, 2016 and 2017. Allocation for 2015 wasN3.94biiloin, 2016, N3.87billion and N3.2billion in 2017 and the funds were voted for, “upgrading and provision of necessary drugs and equipment”.

According to the lawmakers, despite the huge allocations, the presidential clinic was in so deplorable a state that the president’s wife Aisha raised an alarm. The State House Clinic did not have even the commonest of medications. Buhari’s daughter also raised issues on social media.

At an event organized by her organization, Future Assured, inside the Presidential Villa, the first lady fired. She said the nation’s healthcare was in a very sorry state:

“Before I commence my speech I will like to be realistic and say a few words concerning healthcare delivery system in Nigeria. The Nigerian health sector is in a very, very, very poor, sorry state to say the least.

“Few weeks ago, I was sick…they advised me to take the first flight out to London but I refused to go. I said I must be treated in Nigeria because there is a budget for an assigned clinic to take care of us. If the budget is N100million, we need to know how the budget is spent.

“Along the line, I insisted, they called Aso Rock Clinic to find out if the x-ray machine was working. They said it was not working. They did not know that I was the one that was supposed to be in that hospital at that very time. I had to go to a hospital that was established in and out 100 per cent …I am sure Dr. Munir (Aso Rock Clinic CMD) will not like me saying this but I have to say it.

“As the chief medical director, there is a lot of construction going on in this hospital but there is no single syringe there. What does that mean? Who will use the building? You are building new buildings and there is no equipment, no consumables in the hospital and construction is still ongoing”

Meaning, that interest was more in raising infrastructure rather than equipping the clinic with needed goods and equipment. Meanwhile, management of the clinic was making deductions from salaries and allowances of the staff without explanations. Outcome of that investigation was never made public and the clinic is still not in a shape to meet desired needs as the president is still accessing healthcare outside the country.

According to the House of Representatives, the State House Clinic, “was established to take care of the needs of the president, the vice president, their family members as well as members of staff of the Presidential Villa, Abuja” and , “has over the years, been receiving annual budgetary allocations to procure equipment that will enable it to function optimally”. But nobody really cared as the first lady pointed out, to ask how money being disbursed was being used.

In its 2018 budget, the clinic was allotted N1billion aside the sum of N36.8million allocated for “drugs and medical supplies” and a separate N51.8million budgeted as “medical expenses” and another N15.8 million for “digital medical references”. A typical act in the Nigerian governance system.

State House permanent secretary Jalal Arabi, told the House later that the center functions with what subvention it gets.

“Nobody was charging anyone for any services and relying on appropriation means we will depend on subvention when it comes to run the center. Whatever comes is what you utilize and if the last patient comes in to take the last drugs based on the last budgetary release, that is it and we have to wait till another release is done”.

An indication that all is not well with the way budget is disbursed and lack of monitoring for accountability.

Mrs. Aisha’s Buhari’s observation aptly summarizes what goes on in the Nigerian health care system which has left facilities in very, very poor condition making it a death knell for those who solely rely on it for survival. Funding is low and when approved, not readily dispensed to appropriate departments, medical personnel are in short supply and quality of service mostly low as workers are demotivated by internal politics, lack of opportunities to update knowledge or experiment with new technology as well as reluctance in paying remunerations.

Our tertiary institutions which should answer to the call of end solutions to health challenges are those rendered incapable of performance forcing those who can afford to run outside the country in search of good health. Former football captain and coach, Christian Chukwu has just come back from a health trip abroad. He was struck by stroke and help came his way through the kindness of business mogul Mike Otedola, every day the social media features ordinary Nigerians pleading for assistance to access one illness or the other overseas. Kidney transplant seems the most advertised and India the port of the less endowed. Next point are UK, Germany and USA, pooling much needed foreign exchange out of the country whereas with careful planning and commitment, facilities for these and more can abound within the country.

Our teaching hospitals especially, the University of Ibadan Teaching Hospital, University of Benin Teaching Hospital and University of Nigeria Teaching Hospital have recorded groundbreaking successes in healthcare in the past but lack of adequate funding have made them a shadow of themselves, robbing them the right of a place among international health centers. Poor facilities translate to poor and often wrong diagnoses of ailment, a major reason many run outside.

From the Aso Rock Clinic experience, it is obvious that within the budget administration system of the country, there is a conspiracy to defraud and undermine the system as delay in release affects implementation and gives room for actors to dodge responsibility.

Losing N400billion annually in the four last years of the Buhari administration to medical tourism amounts to N1.6trillion, an amount which, if ploughed into the local health sector, would have significantly revamped health care services and provided jobs for some of our unemployed. Unfortunately, rather than plan to stem this, the system is allowed to continue to suffer.

Medical practitioners in the country had in the past called for the proscription of oversea healthcare pursuit by government functionaries as a way of getting them to forcefully improve the state of healthcare facilities and services in the country.

Effective implementation of Primary Health Care objectives, federal government stated priority, has been hampered by lingering inadequate budgetary allocation and improved access, quality and equity in the health sector are enabled by adequate investment in infrastructure, as well as equipment and quality personnel appropriate oversight and effective institutional governance.

Shortage of drugs remains also remains a problem and the non-availability of modern facilities to adequately diagnose illness make treatment burdensome and sometimes unattainable. Poor maintenance culture also makes it difficult for us to have sustainable excellence centers. The National Hospital, Abuja was supposed to answer to that call but it has since fallen in standard so much so that going there now is only out of lack of choice.

Oba Ewuare 11 recently expressed dismay at the state of facilities in the University of Benin Teaching Hospital when the management of the institution called at his palace in Benin City to intimate him on the hospital’s 2019 founder’s day anniversary celebration.

The UBTH established 25 years ago is highly placed in Nigeria’s sector as a center that has recorded many feats in terms of breakthrough in health technology. The tertiary institution has become a rallying point for Edo, Delta and nearby states yet it suffers from poor funding resulting in inadequate facilities. Even bed space is a problem here as in other teaching hospitals including the University of Port Harcourt Teaching Hospital. Lack of needed facilities ensure steady death of patients in critical conditions .

Acknowledging its contributions, the CMD told the monarch that the hospital has been delivering highly specialized services especially in Invitro fertilization, offering hope for pregnancy to many but funding is a problem hence the decision to set up an endowment fund.

Other noticeable gaps in healthcare delivery include the quantity and quality of services offered by unfriendly nurses, non-thorough laboratory technologists and greedy doctors always looking out for their private clinics, drugs and consumables always being demanded from patients even when provided by government all helping to scare many away.

The Association of Medical Doctors of Nigeria has repeatedly called to no avail, for a heath travel ban on government functionaries as a way of forcing government to standardize medical facilities in the country.

National President Nigerian Medical Association Dr Osahon Enabulele at the 39th Ordinary General Meeting of medical workers in Benin City said good government policies will help transform healthcare delivery services.

He called for adequate training for resident doctors to enable them render better healthcare services to the people. The two time NMA president made the call at the 39th Ordinary General Meeting and Scientific Conference with the theme, “The Corollary of Government Policies on Residency Training” organized by the National Association of Resident Doctors of Nigeria, ARDN.

He advocated the institution of training programmes for doctors stressing that for resident doctors to function very well in their duty, there must be constant research, implementation of medical technical template, seminars and education, collaboration with other stakeholders in the health sector as well as accredited training school for doctors.

Dr. Enabulele called on government to do the needful and provide modern facilities in public hospitals to ensure better healthcare delivery for the people and Nigeria.

Medical Director, Central Hospital, Benin-City, Dr. Philip Ugbodaga, in his contribution, noted that incessant strikes in the health sector also affects good healthcare delivery.

In line with Aisha Buhari’s hint at management, Ugbodaga advocated for a deliberate training policy on leadership and management for resident doctors to make them effective in their job.

He also frowned at the contention in healthcare institutions, and called for conducive environment and provision of modern facilities in hospitals.

National president of Association of Resident Doctors, Dr. Olusegun Israel Olaopa, touching on the quality and quantity of medical personnel in the country, disclosed that between 1966 and 2019, Nigeria produced fewer than 11, 000 medical and dental specialists to offer advanced medical services to about 200 million Nigerians. Recall that Dr Ngige said sometime, that Nigerians have more than enough doctors in the system.

“This figure is given with a sense of optimism because not few of these categories of doctors have left and are still leaving for better opportunities around the world. Nigeria currently has not less than 73 tertiary health institutions, whether federal, state or private, where residency programmes are undertaken, but none of these institutions,

meets the requirement to train anyone to be a specialist.’’

He blamed much of the problem on poor political will. “One of the problems, that appears conspicuous to us as an association is the will of the political elites, towards policies that guide not only the residency programme, but the Nigerian health system at large.’’

Edo State governor Godwin Obaseki who also spoke at the event agreed stressing that developing the healthcare delivery system in the state is one of the major projects of his administration and having the right work force is key.

“Since it has been identified that government policies have critical effects on residency training outcomes, I believe we are on the right

course towards achieving viable road-maps for better service delivery and greater fulfillment of broad-based expectations. We are quite aware of the correlation between the quality of healthcare delivery system of any society, and the possibility of the society achieving the dream of becoming an advanced society, ’’ the governor said.

Urging harmony within the health system the governor stated, “It is imperative for government to keep deploying the right policies toward healthcare improvements and accessibility. It is vital for the various players involved in healthcare management to work in perfect synergy.”

“We should strive towards shunning unnecessary rivalry, bickering, contestations, and all manners of industrial disharmony. This we must do for the gain of humanity and the hope of a better future. We must all keep working towards adequate, satisfactory, constantly improving and
affordable healthcare deliveries, which are critical to the well-being and survival of mankind”, Obaseki admonished.

The truth is that a government that truly cares for the wellbeing of its citizenry will strive to always improve its service delivery system and the health sector is a vital one to do so. Investing in upgrading facilities, training and re-training medical personnel, researching to break new grounds and changing work attitudes will help in transforming the sector and position it to earn enough trust to stop the drift to other land in search of health. That will also cost citizens less and conserve much needed foreign exchange which can be ploughed into other sectors to reinvigorate the economy and create jobs for the unemployed.

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