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Medical tourism: Why most people prefer to travel abroad for medical check-up and treatment.

Posted on: April 9th, 2018 by The Moderator No Comments

The Octagon: Welcome to the Octagon. Let’s begin with some introductions before going into the discussion. Can everyone let us know who they are and share a bit about what they do?

Dr Lanre: Good evening all, I’m Lanre, a doctor in Lagos working in HIV/AIDS programming.

Dr Temide: Hello everyone. I’m Dr Temi. I work in health promotion and improving health awareness. It’s good to be here today.

Dr Elizabeth: Good day. I am Elizabeth. I am involved in health education and promotion.

Dr Opeyemi: I’m Ope Owoseni, a physician with special interest in gastroenterology/hepatology

Dr Ayo: I am Ayo, I am a Plastic Surgeon

Dr James: I’m called Osareme. I’m a Medical Officer in Lagos.

Dr Grace: I’m Dr Ikpa Grace, a medical doctor with interest in health management.

Dr Modele: I am Lanre Modele a care coordinator at Hygeia HMO.

The Octagon: Welcome once again, we’ll begin right about now.

The Octagon: Nigeria has 87,000 doctors registered with the Nigerian Medical Association, out of this number 35,000 registered doctors actively practice in the country, this leaves 52000 registered doctors that are unaccounted for. Of the 35,000 registered doctors actively practicing in the country, 24500 practice in urban areas where only 57.7m of the populace lives, while the remaining 10500 practice in the rural area where 153.8m of the populace live. The standard Physician – Patient ratio endorsed by WHO is 1:600, however the above statistics gives a Physician – Patient ratio of 1:2353 in urban areas, while the Physician – Patient ratio in rural areas is 1:14647. In order to attain the WHO standard Nigeria needs an extra 285,345 doctors to make 320,345 doctors to match the ratio of 1:600.

This is both physically as well as numerically overwhelming.

In speaking numerically, let’s look at the financial angle; Nigeria’s 2017 budget allocated a paltry N304b to the health sector representing about  4.3%  contrary to the recommended 15 percent by African Union countries in the 2001 Abuja declaration which commits member nations to improve national health budgets.

In a NOI poll as published by Nigeria health watch some top factors contributing to Doctor’s migrating to foreign countries include huge knowledge gap and low work satisfaction. Countries migrated to in descending order include: Britain, United States of America, Canada, Saudi Arabia and so on. This depletion in work force as evident by the statistics is just one of the many factors that contribute to medical tourism.

 In your own opinion, what are the pressing factors that contribute to people traveling beyond the shores for medical care?

Dr Elizabeth: Poor job satisfaction in terms of salary and facilities available.

Dr Temide: As you rightly mentioned, there are many factors. People seek healthcare abroad because they don’t have information on health services available here in Nigeria. They wind up spending much more than it would cost to treat them locally.

Dr Lanre: Poor infrastructure in most hospitals, long waiting time in public health institutions due to the doctor to patient ratio already mentioned above and an overall loss of confidence in the average Nigerian doctor by some of our elite Nigerians.

Dr Elizabeth: Poorly implemented health policies

Dr Temide: And in some instances, it is simply because they can afford to. Many people believe that Nigerian healthcare professionals are negligent or incapable of managing their health. And because they have the money or are in official positions, they would take what seems to be the safer option. We cannot also deny the poor infrastructure in many government health facilities.

Dr Lanre: It would cost them a lot more, but they get convenience after spending this money often times. Which is occasionally lacking in our current health system.

The Octagon: Could you expand a bit more on this?

Dr Temide: I agree. But sometimes this convenience can be quite expensive. Not only pocket wise, but also health wise. Some of these countries we patronize have medical laws different from ours. And some of the specialists patronized don’t actually give the best care.

Dr Opeyemi: I believe its many things. Inadequate information on the available health care, unavailability of quite a number of services and when available, they are scattered all over the country. CT scan in Oshodi, MRI at Lekki, endoscopy in Surulere, etc. Also the behaviour of hospital staff leaves a lot to be desired. They may be overworked, poorly treated and hence couldn’t care less about good customer service. In addition, I also think traveling abroad is a status symbol, and some people would rather their health status remain secret, which they may not get here.

Dr Lanre: Our health system hasn’t been given the room to develop as it should because of poor financing from both the public and private sectors.  Even our health insurance system that was supposed to bail us out, has been looted and the average HMO client at a hospital isn’t given optimal services. If this client could afford to go abroad next time, I believe he/she would.

The Octagon: As mentioned above, infrastructure plays a big role in the migration for medical reasons. However, do you think that we can maximize what we currently have and the medical personnel who are being unaccounted for?

Dr Ayo: Well the health care personnel are also under skilled

Dr Lanre: I believe to large extent a number of doctors and patients are still around maximizing what we have currently. No matter how good the system abroad is not everyone can run to assess it. So we can only still try to give our best to the system as we remain here.

Dr Elizabeth: You’re right. Many people are ignorant about the level of expertise of health professionals in Nigeria. Those that are aware lack trust. The average patient that has some form of health insurance cannot be given optimal care because the hospital will want to cut cost in order to make profit

Dr Ayo: The hospitals are also poorly equipped, management is also very poor. Seriously hospital management is one of the worst management I have seen in Nigeria.

Dr Temide: Infrastructure does largely impact our health system in Nigeria, but we can maximize what we have. First we have to value it. We have to value our healthcare workers. Better remuneration, improved working conditions and hiring more staff would go a long way to keep health professionals here and maybe bring some back home.

Dr Temide: Second, we need better health policies that provide for health access for every Nigeria as well as better health facilities. In my opinion, things are this bad because most Nigerians don’t understand that access to healthcare is a basic right. And this happens because they’re largely uneducated. A large number of Nigerians are uneducated!

Dr Temide: Third, we need policies that support the growth of private healthcare businesses. If we viewed healthcare as a potential GDP-raising industry, we would be more inclined to invest in it. Nigeria can also be a destination for medical tourists

Dr Lanre: I totally agree!

Dr Grace: Sometimes though, medical tourism is due to greed on the part of doctors. A typical scenario – most medical tourist reps from India pay incentives to doctors who refer patients to their facilities and it’s usually a percentage of the total sum the patient is expected to pay. Now assuming a patient needs a surgery that can be successfully done by a neurosurgeon at Luth (at a different rate in private wing if the patient prefers), but encounters a doctor elsewhere who has such a partnership agreement, he’d end up in India spending more when he could have spent less.

Dr Lanre: Interesting!  Never knew this was happening.

Dr Temide: This would happen. More people would have heard of surgeries in India than of a good neurosurgeon in Nigeria.

Dr Opeyemi: I’m not so sure about that. Going to India may actually be cheaper the way things are now. He may need serial brain imagining that has to be done outside LUTH because the machines are epileptic. An ambulance has to be paid for. Relatives have to be on ground to run around, accommodation for these relatives, drugs may not be readily available etc.

Dr Lanre: This is true and there’s still that ever growing aspect of medical tourism: “The USA baby boomers,” Who are not really scared of delivering in Nigeria but just want citizenship status for their babies, now that goes a long way beyond what any medical practitioner can correct.

Dr Grace: True

Dr Elizabeth: This happens because the country is a mess. A citizen of a developed country like UK will care less about citizenship of U.S.  Nigeria is in a mess and both the masses need to focus on restructuring every aspect of the country.

Dr Elizabeth: I also think a form public-private partnership system in the health sector can solve some of the problems being encountered in the teaching hospitals. Nobody cares because it is government service. The management could as well wreck it to the ground because there is little or no reprimand.

Dr Temide: I believe this is because there is greater access to this kind of information – medical care in India and the likes- online. Generally, in Nigeria’s health industry, digital marketing is underutilized. And this can be traced to the laws restricting health professionals from advertising their services.

The Octagon: In what way can appropriate information be adequately dispersed to shore up the currently available medical services in the country?

Dr Grace: Recently the minister of health in punch newspaper said that Nigeria needs to train more doctors and build Primary Health Centres for them to work as the total number is grossly inadequate. He obviously failed to account for the underemployed and/owed doctors in the private sector.

Dr Elizabeth: Health care can only become a GDP-raising industry if it is invested in. It is a long term beneficial industry. However, remember that most people will rather invest in a venture that will yield maximal profit in a short term.

Dr Opeyemi: True

 Dr Grace: There should be a campaign to review the law banning advertising by doctors/hospitals. That’s one important factor to blame for widespread ignorance.

Dr Elizabeth: Health should be looked at from the angle of long term benefit. Government should be ready to spend. People should be held accountable for the rot in the system and only doctors with proven managerial skills should be allowed to head hospitals.

Dr Grace: Emphasis on proven managerial skills. Running around in hospitals is another reason people who can afford to travel abroad do so.

 Dr Elizabeth: That is due to the way the hospital is set up and poor management. If it was a private hospital, I doubt the owner will leave clients to run around helplessly.

Dr Temide: Thank you for this question. I believe strongly in preventive medicine. There’s not enough health information out there for people to use. We need to invest in this. It’ll make healthcare less expensive in the long term.

Dr Lanre: That law banning advertisements really needs to be dropped, because there’s still a great deal of ignorance about Healthcare systems generally in Nigeria and only by access to this information can the average patient know it exists. Even the TBAs and herbal homes advertise and take away some of our clients

Dr Temide: I always feel pained when I listen to herbal homes advertising their own type of care/products which can be quite dangerous to the vulnerable public.

Dr Opeyemi: That’s good, but when there is a disease, you need treatment. Most people don’t travel for preventive health care.

Dr Elizabeth: Everyone involved in the health sector should be involved in raising and promoting awareness about available expertise and facilities as regards health practice locally. We also need to gain the trust of Nigerians because the average Nigerian lack basic trust in the country’s health sector

Dr Temide: We can also consider having an accessible database on medical professionals in Nigeria, where they consult and how to access them.

The Octagon: Governments around the world understand the need to be deliberate about advancing their economies. What in your opinion are the things that these countries are doing to ensure that people from around the world come for medical treatment and check-ups?

Dr Elizabeth: These countries have solid health policies that are being implemented. There is massive investment in the health sector with good remuneration for health workers.

Dr Temide: These countries make it easier for people to enter them for medical care. For example, India has a medical tourism visa.

Dr Opeyemi: They have invested in training personnel and advertising their services and facilities.

Dr Elizabeth: The health sector is also being promoted via advertisement with promises being made and fulfilled.

Dr Lanre: They constantly advertise their health parks and healthcare cities. A planned health park in Lagos could help reduce medical tourism.

Dr Temide: These countries have been able to retain their healthcare professionals with good remunerations and better working conditions. This is one reason why professionals from less developed countries migrate to these places

Dr Elizabeth: Take the UAE health care for example. If you have seen the advertisement of her health system, it is really inviting. That is the power of advertisement. Of course you never get to see the slums and the less inviting parts. That is because they have taken charge of how their country should be portrayed.

Dr Lanre: Everything about UAE is inviting!

Dr Elizabeth: The laws in banning advertisement should be modified. Meanwhile, we all that are involved in the health sector can find a way around this by massively promoting the health sector on social media. But then, can we do this when the workers are still fighting for good working condition and payment of salary.

The Octagon: In parting, could you share what you believe are the ways to change/solve the current situation?

Dr Elizabeth: Formation and implementation of strong health policies, massive investment in the health sector will go a long way in changing the current situation.

Dr Lanre: Be as professional as we can when we have the opportunity and to educate every patient appropriately so they return to see a doctor. Pushing for proper health insurance legislation and health advertising. Always keeping at the back of our minds not to be like our current leaders when we attain their positions, because if we don’t have the right hearts and minds in these positions we’ll keep frustrating the sincere few who want to improve the health system in Nigeria.

Dr Opeyemi: Adequate funding, including facilities, training, and remuneration; good and achievable health policies and implementation, good health management.

Dr Temide: We need to invest in health. We need to advocate for universal health coverage. We need to provide better remuneration. We need to train more healthcare workers. We need to portray our healthcare system in a positive light. We need to improve the quality of care available. We need to support the development of private healthcare businesses. We need better management. There’s a lot to be done.

Dr Grace: For health workers, we need adequate training (to a level that enables us compete with our counterparts worldwide), conducive working environment with the required facilities, good and regular remuneration. Also retraining on communication and interaction with patients and their relatives. While for the public, we need to educate them and regain their confidence.

The Octagon: Thank you all for participating in this discussion.

Nigeria’s Medical Industry: Ascent or Decline

Posted on: December 6th, 2016 by The Moderator 1 Comment

Welcome to the Octagon Room
Thanks for taking time out to join this conversation which will end in 1hour. Before we go into the discussion, Please let everyone know your name, and a little bit about what you do.

Olamide: Hello everyone. My name is Olamide Craig and I am a Family/Occupational health physician. I also write a column on BellaNaija called AskDrCraig.

Uju: Uju Okoye, public health physician/Healthcare consultant in the US. I work with HIV policy here and also run my own consulting company.

Omolola: Hi, my name is Omolola Sokoya. I’m a Managed care Nurse with with United Healthcare International incharge of case management and quality assurance

Nene: Hi, I’m Nene Usman. I’m a public health physician. I work with Kaduna state university.

Lawal: I’m Lawal Bakare. I trained as Dentist, practiced for two years and have since moved into health communications. I currently run: EpidAlert (formerly EbolaAlert), HEIT Solutions, Chora and also serves as the Technical Assistant on Communications to the CEO of the Nigeria Centre for Disease Control.

Kanyinsola: Hello everyone. My name is Oluwakanyinsola Fowler. I’m a clinician with an MPH. I work as a Senior Analyst at the Private Sector Health Alliance of Nigeria.

The Octagon: Thank’s everyone.

According to an interview with the president of MDCAN. “Nigeria’s Public health sector is an unstable one. The incessant strike by health professionals has been identified as a major contributor to the country’s poor health indices.

Over the years, this has brought untold hardship, sufferings and death to many families and patients across the federation. It has forced many people away from public hospitals to privately owned ones where cost of services is prohibitive and hardly affordable. Many others too have had to rely on traditional medicine as an alternative. “

He further expressed how his professional colleagues had not been able to make any meaningful impact in health care delivery in the  country.

While these are valid concerns, we believe that there are many issues with the Public Health Sector in Nigeria.  In your opinion, what are some of the challenges the sector faces ?

Uju: My responses will be completely from the outside looking in. I think the biggest issues lie around governance, sustainability, infrastructure and cultural. One of the biggest flaws is expecting clinicians to somehow have the administrative tools to manage the  system. Nigeria has a unique problem because of our population. While it is also easy to blame governance, the attitudes of some clinicians sometimes helps to compound the already dire situations. Even with proper financing, there is still  lack of understanding even within the healthcare system, on how to create a system that addresses the Nigerian problem, rather than one that copies the NHS and foreign models.

Olamide: It is easy to fault a large chunk of what is Nigeria’s health care system when comparing it to the UK. And while this and other systems in the developed world are a standard to aspire to, my responses will first attempt to assess the Nigerian system in relation to itself and after this I will go ahead to  compare it to the gold standard. Nigeria has an informal  health care system. There is nominal government oversight but this is perfunctory at best.

Kanyinsola: Governance is the key challenge – Good governance will go a long way to address infrastructure, sustainability and cultural issues.

Nene:  The health sector is poorly financed. Human resource for health is also a problem. Health centres in rural areas are poorly staffed and most times d staff available are unskilled in life saving techniques. Primary health care PHC is d bedrock of our health system and ensures that every Nigerian has access to health care. However, the areas with the greatest need are the areas with the largest gaps. There is also the problem of inequitable distribution of resources. Finances, human resources, materials such as drugs, vaccines etc are usually sent to urban areas. Most people would refuse to work in hard to reach areas. Then there is the problem of misuse of government allocated funds. Every health system relies on these building blocks: leadership/governance, financing, health information systems, human resource for health, service delivery, and materials like drugs, vaccines etc… Each one of these areas is seriously lacking in this country… any solution will have to use a multi pronged approach

Omolola: Our health sector is poorly financed and this balls down to poor goverance. Our primary health care system is faced with challenges , and there is an urgent need to improve the quality of service delivery there. There is also a need to expand it to many communities who still lack the presence of any health facility.

Lawal: From my close observation I feel poorly developed consumers have created weak expectations. That may be the reason all key stakeholders have no reason per se to do anything differently.

Olamide: Training. Let’s not forget training. The West African and National colleges are still boys clubs.

Uju:  I agree. But are those even leading the healthcare system equipped with the right administrative and healthcare management training to manage effectively? Sure everyone is a skilled and talented Clinician but without that, there will always be an issue. Misuse of government funds and corruption happens everywhere. It is not unique to Nigeria, so we really must work around that issue.

Olamide: Public health is dependent on foreign aid. Polio, Measles,  Cold chain, are all funded by donor agencies.

Uju: Great point you just highlighted. This is so absurd.

Kanyinsola: Too dependent on foreign aid.. sometimes I wonder what will happen when the aid ends. Guess we’ll soon find out.

Lawal: Measles funding froze for some months this year and the laboratory surveillance grounded. That’s what will happen when the funds are out. There is an existing solution in our strategic healthcare plan. That document simply needs implementers. In Rwanda all public activities are tailored to their national plan. The reason they seem like magicians. If we can prioritize that plan, we will be fine.

Uju: But wouldn’t it be unfair comparing Nigeria to Rwanda given the enormity of population?

Lawal: That’s a joke Uju. Nigeria’s resources matches our challenges. We are not as complicated as India, Not as complicated as China. Rwandans sorted out leadership quickly. Leadership is the priority of our health system revamp strategy as documented in the plan. I do not think Nigeria should even compare herself to Rwanda. Rwanda is far behind Nigeria in human capital. To fix leadership is a bit of a Long walk.

Olamide: But India like Nigeria is an informal system. Most of the health care is private. And that’s why our challenges have to be tackled differently.

Omolola: I totally agree we have more than enough resources to match our challenges in this country. Our problem is putting this resources into good and proper use.

Kanyinsola: I wouldn’t call our system informal: not organized and poorly managed but definitely not informal. Well we need good leadership that’s ready to get down to business; get their hands dirty. To tackle all of the challenges including the attitude of the health workforce and resource allocation.

Olamide: Okay. Point taken. Poorly organised. However how do we organise it? What do we do in the interim ? Cuba had a repressive got but some of the best health care, as did Libya. So perhaps good leadership is not a prerequisite for good health care?

Lawal: I was at the campaign frontline during the last elections. Nigerians didn’t ask for healthcare. Given that leadership requires us to bring participation from both sides. Good leadership MAY help fix other functions. It is not a stand alone. We never gave ourselves the chance to prove that fact. Leadership here is not political system. An average Cuban physician is driven by a stronger code of participation.  Sense of belonging and ownership. The zero PMTCT recorded in Cuba couldn’t have happened without citizens too.

Olamide: True. Sense of Ownership is key. That’s something we as Nigerians don’t really have. That National cake mentality was ingrained in us from small.

Kanyinsola: I don’t think that’s entirely leadership’s fault. The typical Nigerian doesn’t pay attention to his health till an issue arises. We bury our heads in the sand or act like it can’t happen to us.  I think the Government’s participation is key. The private sector, CSO, the public and other stakeholders can’t create a sustainable and affordable health system on their own. Proper allocation of resources – Government currently spends almost 70% of the allocation to health on the tertiary level mainly on salaries. You can imagine how much gets to the primary health care level.

The Octagon: Great points raised. What would we consider are the top 3 things needed to be done to solve these issues we are faced with? Is there a way around government participation?

Olamide: Strengthening all arms of our health care system. Our tertiary is very strong and primary is weak. Access to health care in rural areas. Training of doctors and allied health professionals. Strengthening of Institutions. Development of an integrated nationwide  health and informatics system to make access to medical data uniform across different.

Lawal: I am achieving some successes and my ingredients have been:

  1. Participation (for citizens especially elites)
  2. Revamped Consumers
  3. Revamped leadership in public sector (civil servants and political actors)

If we can fix these fundamentals in a democracy. The system will define a sound balance for itself. We have records of free but under-utilized health services. I believe in empowering the system to drive itself.

In the last 10 years the leading enabler of governance in Nigeria is participation according to the IIAG (mo Ibrahim foundation). If we can drive this into healthcare we may be heading for that desired success. We saw it play itself earlier this week with telecoms tariffs.  When we start participating, we start winning.

Kanyinsola: 1. Improved quality of health services (including capacity building for health workforce)

  1. Better leadership/ Governance (Proper allocation and management of resources inclusive)
  2. Increase knowledge and awareness among the public so they can better demand for health services.

Omolola: Access to and afforable health care in the rural areas.

Uju: Great solution strategies raised.Thank you for organizing this platform

Kanyinsola: Thank you for organizing the platform and for inviting me 👏🏾👏🏾

Omolola: Great platform you have. happy to have been a part of it.

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