Daily Trust (Abuja)

5 January 2013

Nigeria: How Nigerians Spend Billions On Medical Tourism

Over 5,000 Nigerians travel abroad for medical attention every month, resulting in the loss of N78 billion annually to capital flight.

Encomiums had trailed the recent refusal of the Kogi State Governor, Idris Wada to seek medical treatment abroad as it is the norm by political and public office holders in the country. The Nigeria Medical Association (NMA) through its national president, Dr. Osahon Enabulele has specifically urged political office holders to emulate Wada for "patriotically" opting to receive medical treatment for his fractured femur in Nigeria against all entreaties to do so.

Unlike Wada, four Nigerian governors are currently seeking medical attention abroad for different ailments, and these are those whose cases have become public knowledge. The NMA leadership said political office holders and top public servants now go abroad for even routine medical check-ups, while raising alarm over the staggering amount Nigeria lose to medical tourism on daily basis. The body disclosed at a press conference recently that over 5,000 Nigerians travel to India and other countries for medical treatmenton monthly basis. It puts the estimated lose to medical tourism by the country to over $500 million (N78 billion) annually.

Also, the Minister of State for Health, Dr. Mohammed Ali Pate, middle of last year, quoting from a study, confirmed the estimated figure spent by the country annually on medical attention abroad. Pate, who was speaking in Lagos, said up to half a billion USD leaves Nigeria annually in the form of foreign hospital treatment in three sub-specialities alone.

"Within the country, significant inequities in access to services exist. This is exacerbated by the fact that of the 63 per cent of health expenditure that is privately financed, 95 per cent is funded out of pocket," he added. In the same vain, while commissioning the Kwara State Advanced Medical Diagnostic Centre, Ilorin, in December last year, Vice President Namadi Sambo said Nigerians spent several billions of hard currencies abroad to address medical challenges.

Investigation revealed that out of the estimated amount spent on medical attention abroad, India earns over $260 million (N40.94 billion) from Nigeria alone, accounting for more than half the entire income Nigeria loses to medical tourism every year.

Each medical tourist is said to spend between $20,000 and $40,000 on average on each trip. India was projected to get up to $2 billion in 2012 from a global medical tourism market valued at $20 billion a year. In fact, Weekly Trust investigation shows that no fewer than 40,000 Nigerians obtained visas from India's embassy in Nigeria last year alone.

Unlike the situation in India, most people don't usually apply for medical visa to Saudi Arabia, because of the rigorous process that is involved while some of them contact their doctors who get the visa for them from the foreign ministry in Saudi.

Experts revealed that before now, medical tourists from Nigeria target developed world like the U.K, Germany and U.S.A, but the lure now take them to Africa countries like Egypt, and lately, neighbouring country like Ghana.

Egypt embassy said 12,000 visas were issued for Nigerians last year, while 3,500 were on medical ground. Dr. Hossam Salah E. Taha, Professor of Orthopaedic and Spinal Surgery, Cairo University, Egypt told Weekly Trust that although he doesn't have statistics of Nigerians seeking medical attention in the North African country, he personally review 50 to 100 cases from Nigeria, and operates upon 30 patients from the country yearly. Professor Taha also said he do come across Nigerians in hospitals across the region as a Visiting Professor, where he reviews and operates on patients and also in Yemen, Abu Dhabi, Iraq among other countries.

Taha said the cost for cases like spinal cord injuries is very high. "A patient comes with a fractured thoracic or lumbar vertebra, the cost of surgical stabilization will be in the range of 8,000 to 12,000USD. If the patient requires rehabilitation, then the cost will depend upon the extent of his neurological deficit ie, extent of paralysis and the length of stay within the rehabilitation facility. I think everyone on the surface of this planet deserves the best possible medical care. So, if you mean by medical tourism care for the critically ill, I definitely see that it is helpful, provided that a safe and efficient transportation is available," he noted.

He, however, said travelling abroad, at least at the expense of the government, should be limited to those patients who do not have their proper medical treatment available locally within their home countries.

Why the lure for medical attention abroad in the first place? While experts blamed wrong diagnoses for the rise in medical tourism, Martin Okonkwo, CEO Martreach Global Services, an agency which facilitates trips for individuals travelling abroad for healthcare, said confidentiality is a major reason many high-profile Nigerians would rather be treated abroad for even minor ailments than staying in Nigeria and have the public know their ailments.

"The elite will always go out, no matter how many hospitals you have here. It is not a Nigerian thing. It is a worldwide thing," he noted. Weekly Trust learnt that arranging treatment for patients abroad is a big business for the agencies.

"We have contracts with hospitals abroad that we work with. It is not about business, it is about health. If government wants to partner with us in any way to fix the hospitals here, we are ready to partner to bring in those same equipment that our people are running there to. If government wants to fix the healthcare system, they should stop giving these [health and hospital] contracts to real politicians," Okonkwo suggested.

He said fixing Nigeria's health system through public private partnership is the only sure way of ending medical tourism in the country. "As long as you give it to people in the system, it will be business as usual, because they will run it like a government thing, take their profit and kill the business, but if you bring people who really honestly want to help, they will run it as per the way it should be run: as someone who knows the cost of life," he observed.

Also, Tony Ephraim, President, Guild of Medical Directors, also believes that the PPP can help shut down medical tourism. " The PPP will work. In the private sector, we have able hands. It is only now that the government is realising we have qualified people who can do most of the things people go to India for medical attention. Take Chivar, Cedar Crest, there are many like that that are able to do things that are being done in India. It will also seem it will create a divide in terms of how much Nigerians are able to afford in healthcare. These services will be expensive.

In the private sector, they are not subsidised, the government is not helping. It is only now Jonathan has decided to bring few things to help the private sector. Ephraim agreed that medical tourism is a cartel. "Up to the taxi driver out there benefits. They have a connection down the line until you get to the hospital and back.

"But gradually we are trying to break it, because we have been able to see it early enough. We have seen that they are trying to erode our functions and destroy our work; so the best thing for us is to make sure we really stop it. The oil is for all-comers, but for the medical it is purely professionals who are in it. So it will professional to professional," he noted.

Professor Taha also suggested ways of ending medical tourism. "I think the best option for countries like Nigeria is to have a planned and well organized visitation programme. This will provide several advantages. To find out the travel cost for 100 patients treated in every visit, instead of flying 100 patients at different times. Secondly cost is cut drastically. Thirdly most of the money will be spent in Nigeria; the local economy gets a boost instead of other countries. Fourth it is more comfortable for patients to have their treatment among their communities with their families around. Fifth these visits allow training for local doctors and other paramedical personnel. None of that will be available when you send patients abroad. He said as country has the opportunity of most specialized, experienced physicians that can give the best service so is it not limited to a certain facility or hospital with its limited staff. "This will gradually build confidence in the local health facilities something that lacking in your community," he proffered.

Nigeria experts said high tech procedures and services are now available in the country. Dr. Evaristus Azodoh, Consultant Urologist, Chivar Clinic, Abuja said such facility are operational in hospitals around the country especially in Abuja.

"One is the extra-corporeal shockwave lithotripser, which uses short pulses of radiation to crush stones in the kidney and bladder, without any cut or need for surgery.

"The procedure takes about 45 minutes, cutting down hospital stay and risks of infection. But bigger stones will need further sessions. And for those that cannot be got from outside the body, a laser-based lithotripsy can go into vessels where blockage with stones is a problem.

Each sessions costs around N200,000, and Azodoh says the procedure not only saves patients the cost of international travel but also allows them to be better managed.

He said among cutting edge services coming to Nigeria are assisted reproduction and medical imaging. He also said some private hospitals are upgrading their medical imaging units with MRI (magnetic resonance imaging), CT scan, mammograph machines which scan for breast cancers, ECG to check for cardiac problems. The Federal Staff Hospital, Jabi, according to him, is among public hospitals equipped with CT scans.

Dr. Olalekan Olatise , a Consultant Nephrologists and CEO of Zenith Medical Center in Abuja said as far as kidney ailment is concerned, it is really not necessary for Nigerians to travel abroad for treatment.

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