Prof Rotimi Jaiyesimi
MEDICAL TOURISM AND TOURIST – A MISNOMER?
Medical tourism as a phrase was first used circa 1980 and it describes international travel for the purpose of receiving medical care. The practice of traveling internationally for surgery, however, is a relatively recent phenomenon. Many patients engage in medical tourism because the procedures they seek can be performed in other countries at relatively low cost; Nigerians who travel do so because of the lack of facilities to treat them in Nigeria or due to the lack of confidence in the quality of the nation’s healthcare.
HEALTHCARE IN NIGERIA Previous Nigerian governments have failed its people in the provision of quality health care. This has resulted in people dying unnecessarily and the very few who can afford private or overseas treatment. 145 women die in childbirth every day while 2,300 under-five year olds die daily, making the country the second largest contributor to the under–five and maternal mortality rate in the world. Every single day, Nigeria loses about and women of childbearing age.
The cost of treatment in an accredited health facility in Nigeria may be described as exorbitant when the nation’s gross domestic product is taken into consideration. I have no issues with private health care costs within Nigeria as these are driven by market forces and open to those who can afford it. It is important to note that these institutions have invested in the provision of these facilities and should rightly expect a return on the investment. The high quality care of accredited institutions could act as drivers for healthcare improvement in Nigeria.
In 2013, the Federal government budgeted N270 billion (Naira) for the health sector, (5.5 percent of the Federal budget), in 2014, the Federal government budgeted N216.40 billion (4.4 percent of the Federal budget and a 20.73 % decrease in the actual value of the health budget). 5.5 percent of the national budget (N237 billion) was allocated to health in 2015.The current government has budgeted N221.7 billion for health in 2016.
A budgetary allocation of 4 – 6% is grossly inadequate to provide Nigerians with quality healthcare. Have the previous allocations touched the lives of the many Nigerians who require healthcare or lined the pockets of budget holders? While many Nigerians die from poor access or poor facilities, 30, 000 Nigerians spend about US$1 Billion annually on overseas treatment. The Nigerian population is about 180 million and the budgetary allocation required to provide a safe and efficient service is 15%, a far cry from the current paltry allocation. It is this sorry state of Nigeria’s health sector that has led to a small proportion of its large population seeking treatment abroad and in doing so, expending Nigeria’s money to support and finance foreign health institutions.
THE TERMINOLOGY ‘MEDICAL TOURISM’ OR ‘HEALTH TOURIST’ TRIVIALISES ILLNESS Medical tourism is the travel to another country for the purpose of treatment. I despise the word tourism. Tourist? What’s in a name you might say? You arrive at the immigration posts of these countries without evidence that you have not paid the large sums of money required for your treatment. The reception is not that of an individual who has come on a sight-seeing leisure tourist trip. You will be viewed as an individual in need of healthcare who has come to their country to fleece their country’s resources. There are situations where complications require additional payment than the anticipated expenses? It creates a lot of anxiety and untold suffering. Tourism? Definitely not.
Medical tourism as it currently stands benefits the host nations. Countries that have invested in their health system are now actively seeking Nigerians and other nationalities to come and utilise their facilities at a price decided by them. We now have a growing industry of companies advertising to Nigerians to come overseas for their treatment. We have Medical Travel Facilitators or Medical Tourism Facilitators (MTF) who act as agents seeking to facilitate the outflow of Nigerian patients abroad for medical treatment. I had one such advert placed on this page. It was removed by the company following my protestation that advertising is illegal and morally wrong. I have categorically stated that such money on health care abroad should be used to improve our facilities.
A BAN ON SEEKING HEALTHCARE ABROAD? Travelling abroad for treatment is not peculiar to Nigeria. In 2010, for example, nearly 1.5 million Americans travelled outside their country for medical care. This was a 50% increase from 2007. This is a poor reflection of the American Healthcare which Obamacare is meant to redress. ‘Medical tourists’ may be citizens of developed or developing countries, though affluent individuals from the United States, Canada, and the United Kingdom account for a large proportion of the consumer base. Popular destinations for ‘medical tourism’ include South Africa, India, Brazil, and Singapore, offering state-of-the-art facilities, staffed with qualified healthcare practitioners delivering quality care. In certain situations and countries, these patients are exploited.
To ban travelling abroad for treatment will impinge on human rights. However, Nigerian public servants seeking treatment abroad should be required to demonstrate how they have come to afford such expensive treatment in comparison to their official income (salary). There are specialised treatments not available in Nigeria and I am not advocating for once, a ban on travels for such treatment. Travelling abroad to be treated for malaria is a no go area. It is laughable. Malaria? Yes, and I say this from experience.
REBUILDING THE HEALTH SECTOR IN NIGERIA Charity begins at home. Let’s invest in our healthcare system and stop the exportation of our finances to build other national health systems. It is not enough to build clinics and hospitals. You require qualified dedicated staff, working equipment and adequate remuneration. The health system is akin to an operations system that requires all parts of the processes working together for the good of all. That is what Nigerians seek from its health system – an affordable, locally accessible and safe system.
I am aware of people who travelled to foreign countries in the guise of going on holidays only to take advantage of the health services of these countries without paying for the treatment received. This is probably how the phrase heath tourism came about. The phrases HEALTH TOURIST and HEALTH TOURISM have since crept into our medical, political and lay parlance without reflecting on the appropriateness to describe people who are at their most vulnerable time. I have not heard any patient describe himself or herself as a medical tourist.
The phraseology belittles human misery for they are in no way tourists. It is derogatory. Nigeria plans to build an excellent health system and while serving its citizens, hopes that its health service will be a health tourist hub for Africans. I hope we will expunge the phrase, health tourism, from our vocabulary. I hope Nigeria will build a health service that is consistent in its quality of care and affordable by its citizens. If the government achieves this, Nigerians will have confidence in the health service and will not have to travel abroad. Until such a time, the World Health Organisation, politicians, the lay & medical media and the health professions should seek a more humane description. ‘PATIENTS SEEKING TREATMENT ABROAD’ is an apt description. It could be anyone in such predicament tomorrow. How will you want to be described?