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African leaders and medical tourism

African countries have a lot in common, including a tapestry of shared cultural and economic practices. True, there are numerous relatively distinct ethnic groups across the continent, a shared pattern of social, cultural, and economic practices is discernible.

Equally discernible is the shared pattern of political behaviour and stunted development across the continent. The most frequently identified factors responsible for this situation are poor leadership, weak institutions, governance failure, and endemic corruption.

One of the consequences of these shortcomings is poor health care across the continent. Save for a few private hospitals, whose charges are very high, most hospitals across the continent are poorly funded, under-equipped and poorly staffed. Many hospital laboratories lack the equipment and tools for the most basic lab tests, while their pharmacies run out of basic drugs like pain killers, antibiotics, and anti-malarial medicines.

It is the poor – health care system in Africa that popularised medical tourism – the practice of travelling abroad to obtain medical treatment-on the continent. For Africans, medical tourism destinations include North America, Europe, the Middle East, and parts of Asia, especially India. South Africa is the only known medical tourism destination in Africa.

In 2016 alone, Africans spent well over $6bn on medical tourism, with Nigerians accounting for over $2bn. These could only be conservative estimates as we often do not know how much government officials spend abroad on medical care. What we do know for sure is that the Nigerian federal and state governments spent less than the above amount on health care facilities in 2016. Indeed, the Federal Government’s health budget for 2016 was only about $800m. Worse still, not all of it was released and, of the amount released, a reasonable portion of it must have been misappropriated.

As indicated above, Nigeria is the leading producer of medical tourists in Africa, not simply because Nigeria has the largest population in Africa but also because Nigeria has one of the poorest health care facilities on the continent.

On top of the list of medical tourists from Nigeria are Presidents, governors, legislators, company executives, and their family members. Among the most notorious medical tourists are the late President Umaru Yar’Adua and the incumbent President, Muhammadu Buhari. After repeated medical visits to Germany, Yar’Adua spent three months in hospital in Saudi Arabia, returning to Nigeria under the cover of darkness, never to be seen in public until he was declared dead on May 5, 2010.

The record of his medical sojourn abroad has now been surpassed by Buhari, who has already spent more than four months in London, receiving medical treatment for an undisclosed illness, and his return date remains undetermined. He says it is left to his doctors. It is this lack of specificity about his return, more than the non-disclosure of his ailment, that has generated the most criticisms, expressed in various commentaries and protests.

Nigerian leaders are, however, not alone in the non-disclosure of their illness nor are they the only African leaders who engage in medical tourism. At least four other African leaders are co-travellers.

Jose Eduardo dos Santos, who has been President of Angola for the last 38 years, had travelled several times to Spain for medical treatment, again for an undisclosed problem.

Another sit-tight President, Robert Mugabe of Zimbabwe, who has been in power since 1980, has made three medical trips to Singapore this year alone. His political opponents have accused him of running the country from his “hospital bed” but he says he is going nowhere and he is not dying. He is 93 years old.

In the case of President Abdelaziz Bouteflika of Algeria, his illness is difficult to hide, although its specific cause remains undisclosed. He had a stroke in 2013, which transferred his mobility to a wheelchair. But he has been going to France for medical treatment ever before the stroke occurred, and he has been going there periodically ever since for what his aides describe as medical checkups.

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Even the relatively young President Patrice Talon of Benin Republic, who is only 59, has also been engaging in medical tourism to France. The major exception in his case, which his colleagues should emulate, is the full disclosure of his ailments. In June this year, his government disclosed that he went to a hospital in France for two major operations, one on his prostate gland and the other on his digestive system. The reactions of his fellow citizens have been genuine prayers for his recovery.

Medical tourism by African leaders comes at a huge cost to their countries, which the taxpayers have to bear. This explains the agitation for more open disclosure not only of the nature of their illnesses but also the cost of treatment. In the case of President Buhari, the practice of non-disclosure is further complicated by the duration of his treatment and the uncertainty that comes with it. As I once indicated on this column, this has led to the loss of a human angle to the criticisms as the public sympathy for his condition wanes.

Besides the capital flight that goes with medical tourism, the practice is an indictment of the health care system in African countries, most of which rank poorly on the Human Development Index. The involvement of African leaders in medical tourism accentuates this indictment by further undermining the health care system.

There are even bigger problems: One, political leaders may not have the incentive and political will to improve the health care system at home, if they and their families can go abroad for medical treatment.

Two, the deplorable situation in government medical facilities has encouraged brain drain, leading African doctors to go abroad in search of greener pastures. Today, there are Nigerian doctors in virtually every notable hospital across the United States and Europe. Indeed, many Nigerian patients go abroad for treatment, only to be attended to by a Nigerian doctor or nurse.

For Nigerian doctors, who remain to establish their own hospitals and clinics, the outcome has been pathetic. In Akure, Ondo State, for example, a once notable medical landmark, Dairo and Dairo Hospital, had to fold up after several years of operation. When I last interviewed Dr. Tayo Dairo and his wife, Dr. Dupe Dairo, on why they closed down the facility, their response was typical. In a country where nearly 70 per cent of the population live below the poverty line, private hospitals often have to run at a loss. The situation is worsened by medical tourism as those who can afford to pay prefer to go abroad for treatment.

The question now is what to do to improve the health care facilities at home as no legislation can prevent those who can afford it from going abroad for treatment. For one thing, legislators may not make laws that would prevent them from going abroad for treatment. Besides, the freedom to spend one’s money on medical treatment abroad should not be curtailed by legislation.

One path to a solution is to impress it on federal and state governments to increase the budgetary allocation for health care and then set up enforcement committees at both levels to ensure that the budgeted sums are released and spent as earmarked. The function of the ministries of health should be limited to ensuring service delivery in the various medical facilities.

Until and unless medical facilities at home improve significantly, medical tourism will continue with all its negative implications for health care system at home. Whether or not they are medical tourists themselves, African leaders should muster the political will to improve the heath care system in their respective countries.

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