22viewpoint Buhari and the question of medical tourism
WHile pondering over headlines highlighting the President, Major General Muhammadu Buhari (redt.)’s comment on Nigerians spending so much to attend hospitals abroad, i arrived at two conclusions of which one is likely.
The first is that the Minister of Science and Technology, Dr Ogbonnaya Onu, who represented Buhari at thealex ekwueme Federal University Teaching Hospital, Abakaliki event, may just have been soliloquising.
He may have nursed the thought and wished to speak to his principal about the same for a while. But given the level of sycophancy that attends authority and the dire consequences of daring to speak to power in Nigeria (most frightening of which is losing the public office that may have become a lifeline to the office holder and a horde of people around him), the idea of mooting the discouragement of medical tourism to the President would have been perished. That is as soon as Onu or any other public officer contemplating such is reminded that no other public official had exploited this indulgence as Buhari.
This is so because, he, it was, who spent three months out of the country for medical reasons that the citizenry has yet unclear about. He, it is who jets out on trips said to be short holidays or private visits to the United Kingdom, where everyone knows his doctors might be. it is his wife, Aisha, who recently stayed back in the UK for medical reasons after her annual holiday. This family sure takes a lion’s share of the country’s burden on this front, but this is a terrain where you see or speak no evil.
So, even if any government official had some brainwave about the damage that medical tourism does to Nigeria, mentioning it to the President is comparable to deliberately throwing oneself into a lion’s den. But public events present perfect covers that may even not be noticed by the President, especially as Onu stands in no administrative position to pursue what is clearly a noble intent.
The other possibility is that Buhari truly thinks that medical tourism should end in Nigeria. He, however, may not realise that he has got more work towards achieving this than any other Nigerian. leaders sometimes imagine that speaking about their visions is enough incentive for behavioural change, but transformational leadership is more about the judicious use of opportunities to show positive actions and examples.
That is not to say that Buhari or Onu, (whomever of the two owns the idea), is wrong in this aspiration. it indeed is the way to go for a country committed to the diversification of its economy and saving up foreign exchange. in 2016, then Minister of State for Health, Dr Osagie ehanire, told us that the country spent over $1bn annually on treatment abroad. Such money, if spent here, could do a lot for the economy.
However, changing this cannot be through mere pontification by government officials. In fact, the statement credited to the President at Abakaliki truly says nothing. Hear it: “Nigerians have suffered so much going abroad for medical treatment. This is not good for us and it must stop because we can’t afford it again…”
So, which Nigerians have suffered? True, we want to stop it, but how? And then, the lamest part of the statement is the: “We can’t afford it again.” One is forced to ask, who are those that cannot afford it? is it the country, which is unable to take care of its people? even more upsetting is the fact that we reduce all of this to financial costs rather than the effect of the failure of the health sector on the lives of millions of Nigerians. To make medical tourism a topic of discussion is itself an attempt to further alienate the bulk of Nigerians who cannot even in their dreams, contemplate travelling abroad for any form of medicals.
Just last week, newspaper reports quoted President of the Nigerian Medical Association, Dr Francis Faduyile, as raising the alarm on the frightening state of health care delivery in the country. Speaking at the 10th symposium of the Health Writers Association of Nigeria, Faduyile said there were only 42, 000 doctors available to treat the country’s estimated 200 million people. Although the NMA actually has 77,000 registered members, 33,000 of the number have left the country to practise abroad. To bring the challenge closer home, the NMA President informed that the ratio of doctors in the rural areas is 1:22,000 people, while it is 1:10,000 or 1:12,000 people in towns and cities. When you juxtapose that with the balanced ratio of 1:600 which the World Health Organisation prescribed, you realise that Nigeria has more problems on its hands than tentative lamentations of Onu.
This is one other thing Faduyile said: The United Kingdom employs an average of 12 Nigerian doctors every week. if Nigeria decides to graduate 3,000 doctors every year, it will take us 25 years to meet up with the WHO estimate of one doctor to 600 persons!” Now, that is if all the 3,000 new doctors choose to stay back in the country, a possibility that does not to exist.
The point here is while it is okay to aim at reducing the volume of trips that Nigerians make abroad for medical reasons, a more critical factor should be the well-being of the majority of the people of the country. Of course, people can argue that tackling the first, (which would definitely mean an improvement in the attention given to the health sector) could ensure better access for the populace, but that would be presuming too much. The truth is that raising the standard of health care delivery is not the same as improving access. if attention is focused on stopping medical tourism, a majority of Nigerians will definitely be unable to afford those services.
Government therefore needs to take a holistic look at the health sector. This must start with training, employment and retention of doctors and other health workers. Then, there is the question of funding of public health institutions. At the moment, there is nothing indicating that government understands that Nigeria’s health indices are some of the most unspeakable in the world. This is the sense one gets from the sum of N427.3bn allocated to the sector in the 2020 budget. That is in a country with the personnel situation described earlier. A country where maternal mortality is put at 814/100,000 live births; where neonatal mortality is put at 34/1,000; where 300,000 people are said to die of malaria annually and 102 out of 1,000 children do not live to see their fifth birthdays!
So, government needs to do more than public lamentations. A December 2019 NOI poll indicates that only nine per cent of Nigerians are covered by one form of health insurance or another yet solving Nigeria’s health access challenge depends greatly on this strategy. One realises that the load of Nigeria’s health problem should not be on the Federal Government only, but with Nigeria’s misguided federalism, the onus to mobilise the nation into universal action on the rests on the President, who needs urgent rejig of his own perspective.
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and assembled for accreditation with the state’s electricity Distribution Company taking the blame for the blackout. The science programme in this state university scored 85%! The question i asked myself was: “Why did the accreditation team not request a generator to check one or two of the equipment”?
The suggested scrapping of Post-utme tests in universities by the Minister of education is very unfortunate as this will only encourage the intake of misfits and indolent students who did not write the Jamborganised Unified Tertiary Matriculation Examination by themselves. This does not however prevent a university from conducting an oral examination at no cost to the candidate in order to select the right students for admission.
• Infrastructure and learning resources:
Again, a university that is well-funded must have all the infrastructure needed in place as well as the appropriate facilities for learning and research. The major problems in our universities are the issues of bottlenecks and bureaucratic hurdles that must be dealt with in order to get reasonable amount of money from the Government. As the Dean of Science, University of ibadan, between 2007 and 2009, i was very excited when the Federal Government approved an extended list of research facilities from my office under the Needs Assessment and Tetfund. As of the day of writing this piece, January 3, 2020, over 90% of the approved research facilities have yet to be delivered! The truth is that the Federal Government is really not interested in the provision of infrastructure and learning facilities in the universities she has established. The continued establishment of new federal universities in the country is a clear mockery of education and an attempt to score cheap political point at the expense of the nation. Nigerians are very intelligent people and must not be taken for granted by any government of the day.
• Governance and administration
The Governing Council of a university must comprise highly educated and experienced men and women who have a strong burden on the education of their youths and consequently, on the technological emancipation of this nation. They must not only be creative and innovative but must have excellent rapport with the management of the university in order to ensure her rapid growth and development under their watch. Members of the Governing Council must also be united, courageous and assiduous in the execution of their academic and administrative responsibilities.
On the other hand, the management team must be innovative, responsive and have solid strategic plans to ensure the uplift of the university both in the quality of the teachers and availability of teaching and research facilities. The government, wealthy Nigerians, philanthropists and industries should provide financial support as an incentive to the universities.
To be concluded
• Prof. Odiaka, FAS, is a former Dean of Science, University of Ibadan (2007-2009) and currently Head, Department of Chemistry, University of Ibadan (2017-2021)