Laz Ude Eze
George Egbuchulam was a socially active and intelligent young man. I don’t know him personally but a number of my trusted friends who knew him gave a very good account of him. In 2012, his friends and associates launched a fundraising campaign to help raise five million naira (N5,000,000) required for his kidney transplant surgery at the University College Hospital (UCH), Ibadan. George – a recent graduate of the University of Ibadan had been diagnosed of Chronic Kidney Failure. Inspired by the passion of his friends and their show of love, I joined the campaign from the United States where I was undergoing postgraduate training. A significant amount of money was raised but not as quickly as it was needed. George’s condition had deteriorated to the level that he could not withstand such a major surgical procedure. Painfully, we lost him.
The excruciating pain and outrage that followed George’s untimely death brought health care delivery in Nigeria under scrutiny. Many of his associates believed that George died because he was not flown outside the country for treatment. Abinitio, some of them had no confidence that he would have had a successful renal transplant in Nigeria. No doubt, it was a damning verdict. I disagreed with such conclusion and I will attempt to explain my reasons in the next couple of paragraphs. While there is no doubt that the health system in Nigeria is challenged by inadequate and poor utilization of medical equipment and technologies when compared with other developed countries; it is also true that Nigeria has equipment and capacity to successfully treat many of the medical conditions that cause many Nigerians to engage on medical tour.
Recently, as a guest on Sunrise Daily – a Channels Television breakfast show, Dr Isaac Adewole – Nigerian Minister for Health and professor of Obstetrics and Gynaecology, provided insight into the health policy direction of the present administration and also discussed topical health issues. He reiterated the resolve of the federal government to revitalize at least 10,000 primary health centers across the country. This would help to decongest the teaching hospitals and federal medical centers and allow them focus primarily on complicated cases and research. On medical tourism, the minister said available resources and expertise are being harnessed to discourage this practice. While he may not be able to stop Nigerians who use their personal money to fund medical treatment outside the country, he vowed that the ministry under his leadership would not allow use of public fund for medical tours on health conditions that can be treated in Nigeria.
But why do Nigerian elites prefer getting medical care outside the country? It’s a combination of multiple reasons. Over the years, the health sector has suffered criminal neglect. Politicians mainly construct and commission buildings as hospitals or health centers but do little to get them to function optimally. For a health facility to be able to provide good quality health care, it must not only have good building infrastructure but also competent health work force (including doctors, pharmacists, nurses, midwives, laboratory scientists, medical records officers, etc), regular supply of drugs and diagnostics, good waste management practices and effective monitoring or supervision of practices. To achieve this, sustainable health care financing is required and this has not been the case. Insufficient investment in public health care especially by states and local governments led to poor quality of care and preventable deaths in most health centers and general hospitals. The increased pressure on the tertiary health facilities (teaching hospitals) and the resultant increase in work- load on health care providers at that level have led to unsatisfactory quality of health services. It is this lack of satisfaction that is largely responsible for the loss of confidence in our health care system.
Furthermore, chronic abuse of the government-sponsored medical care by some public officers has contributed to eroding confidence of Nigerians in our health system. In order to earn some allowances, some public officers prefer to travel out of the country to treat medical conditions that can be comfortably treated in Nigeria. The health minister said in his interview that about one million United States Dollars (more than two hundred million naira) is expended on such trips by the federal government on annual basis. In Abuja, I observed that some public officers who had never used local hospitals while in office begin to do so when they leave office or retire from public service. Similar events occur at the state level. Thus, can Nigeria stop medical tourism? Should Nigeria stop medical tourism? If yes, why and how? The truth is that Nigeria cannot stop medical tourism. We cannot stop affluent individuals from seeking medical care wherever they deem fit. But the Government of Nigeria can stop funding medical care of public officers particularly for conditions that can be effectively managed and treated in Nigeria. If the minister for health implements this as promised, it will save the country lots of resources which can be used to improve quality of health care delivery in government-owned health facilities. The minister’s action is necessary but not sufficient, the commissioners for health in the 36 States and the FCT Secretary of Health need to follow suit in order to have a nationwide significant impact.
Revitalization of primary health centers will help to decongest teaching hospitals and allow them focus primarily in providing good quality health care for more complicated cases. Cases of minor injuries, uncomplicated malaria, diarrhea, cough and catarrh are not meant to be treated in LUTH, ABUTH, UNTH or UCH, they can be effectively managed by functional primary health centers. The state governments should expedite action in bringing the management of primary health care under one roof in line with the resolution of the National Council of Health. This will help to ensure efficient management of resources required to deliver quality health services to the Nigerian people especially those living in rural areas. The reason why I believe George’s death may not have been caused by perceived incompetence of personnel that treated him at UCH is because the hospital may have been hugely populated by people with cases that should have been treated at health centers if they were functional. Because of delay in raising sufficient funds for the transplant, his condition progressively deteriorated and made the body weaker. Kidney failure is very debilitating and timely interventions help to improve outcomes. Should there be a public health insurance coverage to treat people in similar conditions? Yes! The “why” and “how” is a piece for another day.
In conclusion, medical tourism is only a symptom of the problems in the health sector. It cannot be solved by single legislation or policy statement. It can be minimized by making highest possible quality of health care available, affordable and accessible for Nigerians in public and private health facilities across the country. Government must seize to fund medical tours abroad for medical care that can be acquired in Nigeria. It will take a combined efforts of policy makers, health professionals and ordinary Nigerians to make this happen. God bless Nigeria.
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Laz is a public health physician, health policy advocate and development consultant. He’s the initiator of the African Youth Initiative on Population, Health and Development (AfrYPoD) and tweets as @donlaz4u.
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