Editor’s Note: Nigerians pay an estimated N3 Billion every year for medical treatment outside the country. In a season where Nigeria is going through an economic downturn, “Medical Tourism” on the surface seems to amplify two problems in the Nigerian health sector; the lack of trust in the existing health infrastructure and expertise in Nigeria, and the flight of much-needed resources from the country. Oluwole Akanji of Medevac Services contributes this week’s Thought Leadership piece. He argues that the medical tourism debate is more complex than meets the eye and highlights what he considers a viable alternative to the current narrative.
Mention medical tourism in Nigeria and the minds of the general public and many of our politicians immediately goes to the estimated N3bn ($13m)) that leaves is spent by Nigerians the country every year to pay for healthcare in India, the Middle East, Europe and North America. The general assumption is that for a country with an economy recently re-evaluated as the largest on the continent, the search for better healthcare services outside Nigeria results from its absence in the country. Medical professionals often argue to the contrary and assert that they are as knowledgeable as their colleagues anywhere in the world. This reductionist debate misses out what is, in reality, a much more complex ecosystem.
International medical tourism out of Nigeria is, in reality, one small aspect of Nigeria’s medical tourism space and does not do justice to this potentially immense, multi-faceted industry. Globalisation has increased the choices that patients have when making treatment decisions. Despite having one of the most advanced health care provision capabilities in the world, nearly 1 million Americans left America in 2007 seeking cheaper more convenient treatment. Consulting firm Deloitte estimates that this will rise exponentially over the next few years. The country of Jordan, through their Private Hospitals Association, managed to attract 250,000 international patients accompanied by more than 500,000 companions in 2012, with total revenues exceeding $1Bn.Similarly, medical tourism is a growing sector in India, the most often cited example in Nigeria. India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a $2 billion industry by 2015
The potential for “Regional Medical Tourism”
The Nigerian health care industry continues to obsess over the loss of $13m annually rather than concentrating on the potential for attracting patients from a global market to seek care in Nigeria. There is definitely a large pool of patients from Nigeria that leave because travel is the only chance they have in obtaining the care they need to stay alive. However, we also have to accept that some people will always seek care outside Nigeria and accept that no bans or prohibitions will curb that.
Efforts should, therefore, be re-focused to attracting patients from one part of the country to another where the quality of care provision is better. Many Nigerians already seek medical treatment outside their home states, either by choice or by necessity. This is an inevitable consequence of specific medical centres in the country becoming excellent in a specific area of care such as renal care or cancer care. Many states have already started to establish themselves as national ‘hubs’ for different specialties. In the USA for example, the Mayo Clinic in Florida draws approximately 20,000 patients annually from other states in America. Studies show that these patients spend more money in the destination where they receive that treatment, boosting the local economy. As the Nigerian healthcare system continues to evolve, we are confident there will be more of this “localization of medical tourism” for lack of a better term, as national referral centres for different types of medical conditions establish themselves, as is the case in many other countries.
Another potential consideration is providing services that bring patients in from the West African sub-continent to receive care in Nigeria. There are nearly half a billion people residing in West and West-Central Africa. If Nigeria could attract more patients from the sub-continent, it will bring with it substantial economic benefits, especially considering accompanying relatives, hotels etc. This is actually not new in other sectors. The trade of goods dominated commerce in West Africa for many years, but over the past ten years, services have grown in prominence as Nigerian banks have spread across the subcontinent, improving the quality of banking services. In terms of healthcare, a number of countries in West Africa have seen their healthcare infrastructure break down completely due to civil unrest, brain drain, and insecurity. While these present huge challenges in these countries, they also present huge opportunities for larger countries like Nigeria who have a comparably more stable and accessible health systems to begin to offer viable, affordable healthcare and treatment options to these countries. This highlights the importance of effective medical transfer services.
The ETU: An innovative alternative for Regional Medical Tourism
One innovation in the health space that currently supports local and regional medical tourism efforts provides faster movement of patients from one state or region to another. The “Emergency Transport Unit (ETU)”, is an Air ambulance medical cabin that can be placed inside a commercial aircraft to transport patients from one location to the other. Patients can be safely and cost effectively transported from one part of the country to another or to a neighboring country where they can gain access to medical care. More cost-effective and accessible than operating a full air ambulance, the introduction of the ETU in Nigeria will make it easier for patients from many West African countries to seek treatment in Nigeria. The ETU ensures that patients can be transferred more safely, in a shorter time period, and with less risk to the patient, than if they were being transferred by road. For example, a road trip from Calabar to Lagos would take a patient 13 hours, but on an ETU, the same trip can now be completed in just one hour. One company that currently provides ETU services in Nigeria is Flying Doctors, which provides medevac services from Nigeria to the sub-continent, to Europe and North America. In addition, government agencies like NEMA recently partnered with the Trauma Centre of the National Hospital Abuja for quick transportation of patients with emergency cases.
FlyingDoctorsNigeria launches #ETU(Emergency Transport Unit).Africa’s most affordable Medical Emergency Air Transport pic.twitter.com/7WeWSJRbbV
— FlyingDoctorsNigeria (@FlyingDoctorsNG) July 30, 2015
Innovations such as the ETU will allow the Nigeria to increase its ability to attract patients from across the sub-continent as well as in country to access better health care services. This, in turn, will help boost the local economy and support the in-country expertise and infrastructure. It will also quell some, even if not all, of the outbound flight of resources for medical care. More than anything, innovations like these are critical if we are to change the dominant narrative around medical tourism in Nigeria. Rather than focusing on what Nigeria is losing every year to other countries, let us focus on how Nigeria can use the potential of medical tourism and the innovative options it brings to refuel our economy and provide opportunities for world class health services to the sub-continent and the rest of the world. It’s time we change the narrative.
Thank you for all your efforts to bring health and health care communication quite differently, I think that your work is making a major contribution to the development of ‘health industry’ in Nigeria which would be a major shift. It is much more about the value chains in health currently locked in and the opportunities for health entrepreneurs to create employment and contribute to expanding the economic space. Health and health care presents unique opportunities to tell and sell a completely different business model of growth and I do hope that those at the Federal Ministry of Health and their Agencies can begin to understand that. It is the intersections between the “social model” and the “medical model” of health in transitioning that we have not been able to connect and thus lock-in vast value chains. Health is the critical link for integrated policy making to pivot domestic policy in Nigeria and to catalyse inclusive growth for sustainable development. The business case for health is so compelling because of its public good nature to return on investment in three dimensions!
That said, medical tourism thrives on the quality of inputs and sadly most of the inputs into health and health care in Nigeria are imported. This has downside micro and macro economic implications which is why we first need to build an industry in health to succeed. I hope Nigeria Health Watch can drive this bigger agenda to protect all the great work that members of your team have been doing. My respect and kind regards.