12 February 2019

Uganda: What Uganda Can Learn From Thailand's Medical Tourism

Medical tourism is the new trend in health care. Thailand, for instance, has made strides in improving its medical tourism scene, positioning herself among the top medical tourism destinations in the world.

Very often, the Health Ministry says some rural health centres fail to attract health workers because they are considered "far to reach" and those areas lack social amenities to entertain the workers.

As a result, patients travel long distances to seek for healthcare leading to congestion in some health facilities.

According to Dr Suwit Wibulpolpraser, the vice chair of Thailand's International Health Policy Programme Foundation, the government, in 1975 launched a medical welfare scheme for the poor and vulnerable citizens.

The medical welfare scheme was based on putting public interest in healthcare first. They trained health workers specifically for rural areas because they shunned working there. Following its success, the Thai government launched the civil servant medical benefit scheme in 1980 followed by voluntary health insurance for the private sector in 1985.

"To stay in a rural area requires people with a committed spirit. We started a system for rural recruitment. We recruit nurses from an area, train them from a hospital and they go back home to work," he said.

After working in a rural district hospital for eight years, they formed a Rural Doctors' Society which discovered a persistent pattern of malnutrition, one they had not been taught about at school. So they created a non-government organisation to fight malnutrition while pushing for more rural doctors. Government, through a policy, later required all doctors trained in Thailand to start their careers by working in rural hospitals before moving to advanced hospitals.

Today, Thailand which produces 3,000 doctors per annum, boasts of 40 medical education centres. These work with provincial hospitals on joint programmes. As a result, 80 per cent of their doctors now work in rural areas until retirement.

To control brain drain a common practice in the 1980s, they stopped training their medical personnel in English and created good working environments in rural areas.

"Today, nurses feel proud being called directors of rural hospitals because they know people depend on them," he said. As a result, Thailand with a population of 68 million boasts of 927 government hospitals and 363 private hospitals with 9,768 government health centres plus 25,615 private clinics.

Uganda's plan

Asked whether Uganda plans to replicate medical tourism, Prof Francis Omaswa, the former director general of health services who has been instrumental in setting up Uganda's healthcare infrastructure, said in the 1970s. Uganda was ahead of Thailand, Singapore and Taiwan in establishing universal health coverage.

"We had a very successful programme in Kasangati which was supposed to be scaled up. But priorities changed and it was never followed up," he said in an interview.

He added that when he started his medical career, there was a system where students who wanted to study to become nurses and doctors, were recruited as civil servants. They were trained as civil servants and government posted them to work in areas where they were needed. The training was conducted in training schools attached to hospitals mainly Mulago medical school for senior doctors while the nurses training schools also attached to hospitals trained the lower cadre workers. However, that system stopped recently.

Ms Sarah Opendi, the State Minister for health and general duties said they hoped that by this year, Uganda would be ready for medical tourism with the completion of the refurbished Mulago hospital. But construction work is incomplete for the installation of the specialised equipment and the laws for organ transplant are still not in place complicating the process.

"When you talk of medical tourism, you are talking about the renovated Mulago hospital. Unfortunately, we need another $14 million to complete the work because there were unforeseen works which had to be completed," she said adding that the newly refurbished hospital is supposed to have all specialised services located within one campus

According to Prof Pius Okong, the chairman Health Service Commission, training of all health workers is currently done by the Ministry of Education. As the commission which recruits government health workers, they usually make recommendations to the Ministry of Public Service which supervises the government workers but one of the challenges they have faced over the years, is attracting health workers to Moroto, Hoima, Mubende and Kabale regional referral hospitals.

"We would advertise positions for referral hospitals and when the applicants learnt about where they were to be posted, they would decline the appointment until we changed the strategy five years ago," he said.

According to Dr Suwit Wibulpolpraser, they have created a large pool of all skilled health workers both high and low end plus complementary medicine facilities such as health spa. These eventually birthed the concept of medical hubs.

According to Pawinee Sangkhaboon Mai, the chief of the Thai Medical Hub Policy, the explosion of private and public health facilities dealing both in mainstream human medicine and supportive treatment such as the Spa and Massage business, forced the Thai government in 2013, to create the Medical Hubs strategy. This identified the booming healthcare business and wellness as the potential economic growth engine for Thailand.

In 2013, a law was enacted - Spa Enterprise Act to promote health tourism. This law created four hubs namely the Medical Service Hub, Wellness Hub, Product Hub and the Academic hub. A medical hub is a specialised advanced facility for medication and treatment of complex ailments. In Thailand's case, these are multi-storey single buildings which accommodate the general hospital facilities but in addition, they have private hotel facilities where discharged patients under doctor review, can check-in since they do not have their own places of residence.

Medical hubs

The medical hubs concept adopted from the United States of America, is now common practice in Asia.

With 64 accredited hospitals, Thailand is currently among the top 10 medical tourism destinations in the world because they can treat complex ailments at a cheaper cost. In 2017, Thailand registered 3.3 million visits of foreigners seeking specialised medical treatment and in 2018, this number grew to 3.5 million.

The 580-bed Bumrungrad International Hospital - one of the largest in South East Asia located in Central Bangkok City - accommodates patients mainly from the Middle East, United Arab Emirates, Oman Bharain, Kuwait, Pakistan and Bangladesh among others.Founded in 1920, the founders wanted a high-end hospital for treating complicated illnesses.

Patient on tour

A patient may be accompanied by caretakers. While the hospital attends to the patient, the caretakers are booked into a hotel that also offers sightseeing services among others. This can also be extended to the patient in their free time.

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