12 November 2012

Nigeria: Health for All Abroad


Based on a global pledge to commit to universal access to health in 1978, governments all over the world enthusiastically mouthed the slogan "Health for All by the Year 2000". Twelve years after that magical year and only two years to the next one, 2015, the pledge of the Nigerian government appears to have become "Health for all our citizens abroad".

Our new culture of going abroad for medical treatment is evidence that our government has progressively contracted our health services to foreign countries whose governments have seen it fit to maintain a robust health sector for their citizens.

The claim by the chairman, Senate Committee on Health, Senator Ifeanyi Okowa, that Nigerians spend N80 billion on medical tourism overseas every year is the most recent admission that rich and influential Nigerians outsource our health services to foreign countries.

The government is no doubt aware of the negative consequences of this practice. An extant circular which bars government employees from traveling abroad for medical treatment with public funds except for special reasons will be in order.

Nigerians who can afford to pay for treatment overseas should do so. However, many that are not so rich are being forced to go abroad because there are few safe alternatives at home. Dying abroad may have become fashionable, but medical tourism is not the only loss of national investment in our healthcare delivery system.

Senator Okowa should extend his timely prognosis to the monetary cost of Nigerian medical personnel who leave home to practise abroad after being trained in local universities as beneficiaries of public fund. The cost of educating many, if not most, of 2,392 Nigerian doctors who were practising in the United States of America and 1,529 in the United Kingdom as at 2005 was borne by poor Nigerian taxpayers.

Both practices of Nigerians purchasing healthcare services abroad and our skilled health personnel migrating to rich foreign lands question the patriotic instincts of Nigerians in a larger number of cases. But the two trends have a common origin in the state of our health institutions.

So, we first need to fix policy constraints and regulatory frameworks that Okowa suggested militate against the healthcare system.

An obvious consequence of poor budgetary allocation is that, as Okowa noted, only 20 per cent of the budget goes into capital projects. Healthcare delivery is on the concurrent list of the three tiers of government.

Our health expenditure pattern indicates that 70 per cent of healthcare is lavished on urban dwellers who form 30 per cent of the population and 30 per cent on our rural population who make up 70 per of the population.

In terms of budgetary allocation, what tertiary level service under the federal government and secondary healthcare under state governments means is that our healthcare services elude our poorest of the poor who need them most.

This class of citizens is more in rural Nigeria where primary healthcare under local governments are in extremely parlous state. Better services are also priced above the urban poor.

In some respects, health is the real wealth of a nation because it is the basis for the wellbeing of individual citizens on whose personal productivity national prosperity depends.

The life expectancy of Nigerians is still comparatively low in World Health Organisation ranking. Deepening the National Health Insurance Scheme will be a good start to restore confidence in the system, offer quality and affordable services as well as give Nigerians choices and retain health personnel.

The scheme needs massive awareness and the support of Nigerians, especially organised labour and employers of labour.

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