As he ascended to power in that historic 2015 vote, President Muhammadu Buhari and his All Progressives Congress (APC) party made a raft of sweeping promises to Nigerians. Stamping out corruption and winning a long-running war against the terror group, Boko Haram, were top of the agenda. So, too, was putting an end to medical tourism, specifically government-funded trips for public officials.
Medical tourism, as it is understood in Nigeria, is the act of government officials jetting abroad to receive medical care for undisclosed ailments even as the rest of the population relies on an underfunded and overworked public healthcare system.
Although his administration officials vowed to put an end to the practice, Buhari has been Nigeria’s most prominent medical tourist. He has visited the United Kingdom for at least five medical trips since becoming president, including an extended stay of more than five months in 2017.
Now, Nigeria’s healthcare system faces an uphill battle it is ill-equipped to deal with as the reality of Covid-19 bites. The country’s elite, so accustomed to quick jaunts to the UK, the United States and elsewhere for their medical needs, are boxed in and reliant on a sector they ignored for years.
Shortage of doctors
Even before Nigeria identified its first case of the new coronavirus in February, the state of its public healthcare facilities had been a cause of longstanding concern that preceded Buhari’s presidency. Top of the list of concerns is a shortage of doctors in a country of more than 180-million people. There are only 75 000 registered doctors, according to the Nigerian Medical Association (NMA), the union for doctors and dentists.
The World Health Organisation designates that any country with less than 10 doctors per 10 000 people is “insufficient”. Nigeria’s ratio works out to about 3.8 per 10 000 people, well below the recommended standard and short of the numbers of emerging economies like Brazil, Algeria and Cuba. And to further complicate matters, the NMA says more than 40 000 of those registered doctors now work abroad.
Nigeria is a top exporter of medical talent to all over the world; its doctors are a permanent fixture in emergency rooms in the UK, the US, Canada, Saudi Arabia. In South Africa, there are an estimated 5 000 Nigerian doctors; in the UK, that figure is 7 500, according to figures from its General Medical Council.
The brain drain is driven by the poor conditions for medical professionals at home. “Nigerian doctors are some of the worst paid in the world,” Dr Yewande King, a Lagos-based medical officer, said. “There is little to no system in place to become a specialist. There are too few spots, with poor working conditions and it takes a significantly longer amount of time to complete training, compared with other countries.”
The doctors left behind have to contend with low salaries that routinely go unpaid. Industrial strikes are a recurrent theme. Resident doctors in Abuja recently called off a strike they had embarked on to protest against being owed salaries for two months. Government doctors in Abia, in Nigeria’s southeast, were last paid in February 2018, the NMA said. Many hospitals lack basic equipment and local media have reported cases of patients sleeping on floors in mosquito-infested teaching hospitals. With electricity generation a nationwide problem, it is not unheard of for doctors to perform surgeries with lamps, candles and torchlights.
Although Nigeria’s leaders pay lip service to the ideal of public healthcare, the budget tells a different story. Although the 2020 health budget saw its highest increase in five years to 440-billion nairas (R21-billion), it accounts for about 4% of the total government outlay for the year, a far cry from the 15% agreed on by members of the African Union in 2001. A sizeable amount of the health budget is spent on recurrent expenditure and not enough is invested in capital projects, according to BudgiT, a civic organisation tracking government spending.
Government officials have often displayed a cavalier attitude to the problems plaguing the healthcare sector. When confronted by a lack of residency training openings for medical graduates in 2018, former health minister Isaac Adewole seemed to make light of the situation.
“It might sound selfish, but we can’t all be specialists; we can’t. Some will be farmers; some will be politicians. The man who sews my gown is a doctor. He makes the best gown. And some will be specialists, some will be GPs, some will be farmers,” Adewole said.
“We have more than enough doctors. You can quote me,” Ngige said. “We have surplus. If you have surplus, you export. There is nothing wrong in them travelling out. When they go abroad, they earn money and send them back home here.”
The healthcare system, bedevilled by years of neglect and underfunding, is now tasked with dealing with a pandemic that has overburdened even the most well-funded nations. Francis Faduyile, head of the doctors union, has sounded dire warnings of a possible “total collapse” of the system.
“The health system is not strong enough,” Faduyile told Bloomberg recently. “Over the years, it’s been denied normal funding and things are not where they’re supposed to be. If the burden of the coronavirus is added, it may be too heavy; it may actually cause a total collapse.”
With 238 cases and five deaths as of April 7, according to the Nigeria Centre for Disease Control, the coronavirus pandemic is the sole focus of the nation. Among those infected are high profile names like Abba Kyari, the president’s powerful chief of staff; four of 36 state governors; and a son of former vice-president and three-time presidential candidate Atiku Abubakar. Suleiman Achimugu, a former state oil executive who recently returned home after medical treatment in the UK, was Nigeria’s first Covid-19 casualty, the Centre for Disease Control said.
Like the rest of the world, Nigeria has shut its borders and enforced a lockdown in parts of the country, leaving its elite in a situation where they have no access to the medical trips abroad they have grown accustomed to.
Several lawmakers and governors are in isolation and may have to rely on public hospitals should they contract the virus. Top tier private clinics may offer some succour, although King warned that even the most sophisticated private hospitals may not be able to cope because there aren’t enough specialists in the country.
“A functioning healthcare system needs doctors who are good at one specific aspect of medicine, for example paediatrics or gynaecology. In Nigeria, you can only get this expertise in federal or state-run hospitals,” she said.
“This leads to very few spots available, in comparison to the demand. This shortage has become more glaring in a pandemic such as Covid-19 where it requires a decent amount of intensivists [intensive care unit doctors] and pulmonologists at the forefront. I don’t have the exact number, but Nigeria has a low number of doctors with expertise in those areas.”
Covid-19 has been described as a leveller and perhaps for the first time ever, Nigerian elites may have to confront the daily realities faced by their compatriots.