African Heads of State, Foreign Medical Trips, and National Security
Professor Ofodile, in this article, discusses the waste of tax payers' money and the risk to national security, occassioned by overseas medical trips, by African Leaders. She also focuses on four main problems which, in her view, arise as a result of such
Less than two months after he returned to Nigeria from an extended medical leave in London, President Muhammed Buhari is back in London, seeking medical treatment for an undisclosed ailment. Sadly, Buhari is not the first African leader to seek medical treatment overseas. Every year scores of African leaders travel overseas for medical treatment, and a few have even died overseas. Gabon’s President Omar Bongo died in Spain in 2009. President Michael Sata of Zambia died in London in 2011; his predecessor, Levy Mwanawasa, died in France in 2008. Ethiopia’s President Meles Zenawi of Ethiopia died in Belgium in 2012. Guinea-Bissau’s President, Malam Bacai Sanha, died in Paris in 2012. They all died in Europe while receiving treatment for undisclosed ailments. They all left their taxpayers to pick up the cost of their medical treatment overseas. Add to this list, former President Umaru Musa Yar'Adua who left Nigeria in 2009 for medical treatment in Saudi Arabia; he returned to Nigeria in 2010, and died shortly after. Oversea medical trips by African leaders at tax payers expense, poses a serious risk to national and continental security, raises questions about widening health inequality in Africa, and undermines the ability of countries in Africa to achieve the sustainable development goals of the 2030 Agenda.
At Least Four Problems with Overseas Medical Trips by African Leaders
First, the optics is simply bad. Very bad. More than any other continent, African leaders are notorious for shunning domestic health institutions in favour of health institutions in Europe and North America. The message from these leaders is very clear: African leaders do not trust African doctors, do not trust the medical schools in Africa that train these doctors, and do not think much of domestic health institutions. More than fifty years after independence, these leaders proudly declare to Africa’s erstwhile colonial masters, that countries in Africa are incapable of establishing basic health infrastructure for their citizens, let alone join and beat other countries in the global race towards innovation and economic dominance.
Second, African leaders who seek medical treatment overseas, and fail to address the decrepit health care system in their respective countries, clearly forget their regional and international commitments as regards the right to health. Article 16 of the African Charter on Human and Peoples’ Rights declares that “[e]very individual shall have the right to enjoy the best attainable state of physical and mental health” and that State Parties “shall take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick.” As part of the 2030 SDG agenda, African leaders have undertaken to “ensure healthy lives and promote the well-being for all at all ages” (SDG 3).
Third, African leaders who travel overseas for medical treatment, could seriously undermine the national security of their respective countries and continental security as well. When African leaders travel overseas for medical treatment, they continue to conduct state affairs from their hospital rooms and from their hotel rooms National secrets and sensitive topics are frequently discussed over the telephones, and vital state secrets are often communicated through e-mails that are transmitted via unsecure servers. What state secrets are compromised, when a sitting president conducts state affairs from hospital rooms in foreign territories? What national interests are threatened when top state secrets are discussed in the presence of agents of foreign powers masquerading as hospital staff? In this era of high-stakes cyber espionage, the cost to Africa of medical trips overseas by their leaders must be measured not only in terms of dollars and cents, but in terms of harm to national interest and national security.
Fourth, increasingly, experts draw interesting and very frightening links between the health of a country and its national security. A country with a sick and an ailing population and a decrepit healthcare system, is a country too weak to safeguard its economic and military security, is a country that is extremely vulnerable to external attacks and public health emergencies, and is one that is not fully productive economically. Professor Dan Agin rightly noted in 2009 that, “[a] public health service is not just a convenience,” but is “a vital party of the national security of a country.” Consider these grim statistics: • According to a report by the International Finance Corporation,
health care in most of Sub-Saharan Africa (SSA) “remains the worst in the world” and “few countries in the region ... spend even the $34-$40 per person per year that the World Health Organisation considers the minimum necessary to provide a population with basic health care.” • About half of the world’s deaths of children under five
occur in Africa. • Although SSA accounts for 11 percent of the world’s population,
it bears 24 per cent of the global disease burden and commands less than one percent of global health expenditures. • According to the World Health Statistics 2016, global life
expectancy in 2015 was 71.4 years. Sadly, 22 countries – all in SSA – have life expectancies that are below 60 years. With a life expectancy of 54.5, Nigeria is in the bottom 10 in Africa and globally in rankings. • Only three countries in SSA have life expectancies that meet
or exceed the global average: Mauritius (74.6), Cape Verde (73.3) and Seychelles (73.2). • Regarding maternal mortality, SSA is the riskiest region in
the world. According to one study, the chances of a woman dying from childbirth over her lifetime is about one in 4,900 in high income countries and only one in 36 in SSA.
National Security Encompasses more than Military Security
According to USlegal.com, national security “refers to the protection of a nation from attack or other danger by holding adequate armed forces and guarding state secrets”. While military security readily comes to mind when national security is discussed, national security encompasses much more than military security. Indeed, national security “encompasses within it, economic security, monetary security, energy security, environmental security, military security, political security and security of energy and natural resources.” When state affairs are conducted from hospital rooms in foreign countries and vital state secrets are communicated via e-mails and telephones, every aspect of a country’s national security are rendered vulnerable and potentially compromised. The secrecy that frequently surrounds the illnesses of African Heads of State, the power vacuum and uncertainty that their extended absence from home breeds, and the constitutional crisis they sometimes leave behind, all pose serious threats to the national security of countries in the region.
Is there a Solution?
Why do African tax payers pay for their leaders to receive health treatment overseas for undisclosed ailments, sometimes at undisclosed hospitals, and for indefinite periods of time? What is the possible rationale for a law that permits leaders to shun domestic health institutions, and to seek medical treatment overseas at taxpayer’s expense? Are taxpayer-funded medical trips overseas considered just reward for good governance or are they be offered to encourage leaders not to loot the state treasury when they leave office? During the colonial era, it might have made sense for colonial officers to go back to the mother country for medical treatment. Today, there is simply no good reason to reward African leaders, who shun domestic health personnel and health institutions in favour of overseas institutions.
Can anyone imagine a U.S. President or the Queen of England travelling overseas for medical treatment, even at their own expense? In the United States, the salary of the President is set by Congress. The annual salary of the President of the United States is $4000,000 per year, including a $50,000 expense allowance. Pursuant to Article II, Section I of the United States Constitution, the president’s salary cannot be increased or reduced during his or her current term of office. Although there is a White House Medical Unit that provides comprehensive medical care to the president, vice-president and their families, these officials bear their own medical costs. The medical expenses of former U.S. presidents are not borne by U.S. taxpayers either. Pursuant to the Former Presidents Act of 1958, former presidents of the United States get a lifetime, taxable pension, but are otherwise responsible for their medical bills. Regarding health care, former presidents and their spouses, widows and minor children are entitled to treatment in military hospitals, but are responsible for associated health care costs. President Obama’s FY2017 budget request sought approximately $3,865,000 in appropriation for expenditures of the then four surviving former Presidents of the U.S.A.
Laws that regulate the salary and pension of leaders are not written in stone and can always revisited. In the U.S. the Presidential Allowance Modernisation Act of 2016 ( H.R. 1777 and S. 1411) sought to limit taxpayers funds to ex-presidents. “Taxpayers should not be on the hook for subsidising former presidents’ lives to the tune of millions of dollars,” Senator Joni Erns, one of the lead sponsors of the bill, argued in 2016. The time may be right for Africans to address and review the laws that make it possible for leaders to seek medical treatment overseas, at the expense of their taxpayers. In Nigeria, it is safe to say that President Buhari did not create this problem and that it will take the collective effort of all Nigerians, particularly the nation’s lawmakers, to address the situation. Several options are certainly worth considering:
1. For each country, a complete transparency about the exact cost to tax-payers of overseas medical treatment by leaders (presidents, vice-presidents, governors, former president’s etc.).
2. Consider a complete ban on tax payer-funded medical trips overseas by African leaders.
3. To the extent that a complete ban is impossible, consider imposing a cap on the amount of reimbursable medical expenses a leader can claim, when such treatment is obtained overseas.
4. Consider imposing restrictions on the types of medical treatment a leader can seek overseas, and the types of ailment for which an overseas trip can be undertaken.
5. Require complete transparency from leaders regarding cost of treatment and nature of treatment.
6. Consider promulgating laws that can regulate the conduct of state business from overseas, when a leader embarks on an extended medical leave overseas. Such law must take into account, the numerous risks to national security that arise when a country’s affairs are conducted from foreign territories.
7. With a view to achieving SDG 3, insist on transparent, integrated and comprehensive national health monitoring, taking into account SDG health and health-related indicators.
8. Pressure foreign hospitals to disclose exactly how much African taxpayers pay them for purportedly treating their leaders, and the nature of these treatments.
9. Insist that African leaders address the widening health inequality in Africa. Studies show that differences in health status in Africa are not the product of chance, but are the result of avoidable differences in social, economic and environmental variables and they can only be addressed by public policy.
10. Demand more resources for domestic health institutions.
Conclusion
It is a continental shame that African leaders seek medical treatment overseas, while their citizens are left to deal with failed and failing health systems. One certainly wishes President Buhari well. Were President Buhari my dad, I would wish him a full and speedy recovery. Were he my dad, I would ask him to think about the millions in Nigeria, who do not have access to basic health care, and to do something about it. Were he my dad, I am confident that he would listen to me and that he would act decisively; my dad was that kind of a man. Unfortunately, my dad passed away about six months ago in Nigeria – after a very brief illness.
"CAN ANYONE IMAGINE A U.S. PRESIDENT OR THE QUEEN OF ENGLAND TRAVELLING OVERSEAS FOR MEDICAL TREATMENT, EVEN AT THEIR OWN EXPENSE?"