By Olusegun Akinfenwa

During his campaign for the 2015 general elections, President Muhammadu Buhari of Nigeria pledged to end medical tourism if elected. However, just like many of his other campaign promises, the 78-year-old leader of Africa’s most populated country has broken this pledge several times. Within his six years as president, Buhari has spent over 175 days in the UK on medical vacation.

For years, the patronage of foreign medical service has become a common pattern among African leaders. From the southern to the northern part of the continent, the situation is the same, and this has left the healthcare system in many African countries in a sorry state. In 2017 alone, President Buhari spent 152 days on medical vacation in the UK. Just about the same time, his Republic of Benin counterpart, President Patrice Talon, also went to France for surgeries. During his time as Zimbabwe’s president, the late Robert Mugabe was also another regular visitor to hospitals abroad. The list includes President Ali Bongo of Gabon, former Presidents Jose Eduardo Dos Santos of Angola and Abdelaziz Bouteflika of Algeria.

In the past few years, many African leaders have died in foreign countries while seeking medical attention. They include Ethiopia’s Meles Zenawi, who died in Belgium in August 2012, Guinea Bissau’s Malam Bacai Sanhá in France in January 2012, and Zambia’s Michael Sata in the UK in October 2014.

While the 2020 coronavirus-induced lockdowns prevented them from flying abroad on medical tourism, the trend seems to have resumed in 2021 as countries ease their travel restrictions. On March 30, Buhari embarked on yet another London medical trip and is billed to return to Nigeria in the second week of April.

The reason for this vicious cycle isn’t farfetched. Many African leaders obviously lack confidence in the health system they provide and oversee. They understand the deplorable condition of their countries’ medical sectors and will not risk having themselves and their families cared for by the poor system. For instance, in 2015, former governor Godswill Akpabio built and commissioned a “world-class” $76 million hospital in his oil-rich state Akwa Ibom of Nigeria, only to seek medical treatment in London four months later after a car crash.

The Effects

Unfortunately, this practice costs the continent billions of dollars annually. In 2016 alone, Africans spent over $6 billion on outbound treatment. Nigeria accounts for Africa’s highest foreign healthcare expenditure, as its citizens spend $1 billion annually. Unfortunately, medical tourism is a luxury that can only be enjoyed by a small minority of the over 1.2 billion African population due to the abject poverty that ravages the continent. Sadly, the poor citizens are the ones bearing the brunt of this selfish and shameless act of their leaders. Its numerous effects include:

• Huge Gap in Healthcare Funding

The year-long negligence and meagre budgetary allocation have left a huge investment gap in Africa’s health system, which will require billions of dollars. Sub-Saharan African is the worst. The region has about half of the countries in the world with an acute health financing gap. In Nigeria, for instance, the latest World Bank data shows that public spending on health care accounts for just 3.89% of the country’s $495 billion GDP. The figure shows a huge difference when compared to developed countries like United States, Germany, and Canada with 16.89%, 11.43%, and 10.79 respectively. According to a recent report from a real estate agency, Knight Frank, Nigeria would need $82 billion of investment in healthcare real estate and 386,000 additional beds to meet the global average of 2.7 beds per 1,000 people. In Ethiopia, a 2015 report showed that there were just three hospital beds per 10,000 population, compared to the United States and Europe with at least two dozen per the same population size. In Zimbabwe, there have been cases of bare-handed surgeries by doctors due to lack of gloves, just as the whole of the Central African Republic’s health sector could only account for three ventilators at the peak of the COVID-19 pandemic in 2020. Africa accounts for 16% of the world population and is ravaged by 23% of the global disease burden. Contrastingly, the continent accounts for just 1% of total global health expenditures, a 2015 report showed.

• High Rate of Preventable Diseases

It is also sad to note that the continent is burdened with the greatest infectious diseases in the world. Since mid-1970, the world has witnessed the emergence of 30 new infectious diseases, and many of them originated from Africa, according to Paul Epstein, associate director of the Center for Health and Global Environment at Harvard Medical School. Malaria, tuberculosis, diarrhoea and various other preventable diseases remain some of the highest killers in Africa. The latest WHO’s World malaria report shows that Africa accounts for 90% of the global malaria cases. While the continent has managed to reduce its overall annual malaria death toll by 44% (680,000 to 348,000) since 2000, some African countries still record alarmingly high annual rates. Six African countries (Nigeria, the Democratic Republic of the Congo, Tanzania, Niger, Mozambique, and Burkina Faso) account for 50% of all malaria cases globally. Africa also has the highest diarrhoea disease cases in the world. Whereas diarrhoea rates are below 5 per 100,000 population in most countries across the world, many sub-Saharan African countries have 50 to 150 per 100,000 population. For instance, in Chad and the Central African Republic, the rates are estimated to be over 150 per 100,000.

• High Maternal Mortality, Child Mortality, and Low Life Expectancy

The continent also grapples with high child mortality ratios, high maternal mortality rates, and low life expectancy, owing to its healthcare system’s poor state. According to a recent report from the World Bank, 54% of child mortality in 2018 (deaths among children under 5 years of age) occurred in the sub-Saharan region. 1 in 13 children in the region die before their 5^th birthday. In Nigeria, the maternal mortality ratio is 814 per 100,000 live births, making it the country with the highest rate globally. In most developed countries, the lifetime risk of a woman dying during pregnancy, childbirth, postpartum or post-abortion is 1 in 4,900. But in Nigeria, the risk is as high as 1 in 22. The inadequate medical care and general living condition have also reduced the life expectancy in many African countries. Africa is home to the world’s 10 lowest-ranked countries in terms of life expectancy, with Lesotho, Nigeria, and Sierra Leone being the lowest three on the list.

• Shortage of Medical Professionals

The system is also very frustrating to medical professionals, leading to a high emigration rate among African-trained physicians. Already, Africa struggles with the shortage of health professionals across its various medical practices. Ideally, the WHO’s recommended doctor to population ratio is 1:1,000. But in reality, Africa can only boast of 1:10,000, and by 2035, the shortage of physicians is expected to reach 4.3 million. A report from The Lancet showed that almost one in 10 doctors in the UK are from Africa. Many of these professionals are on indefinite leave to remain status in the country – an indication that they would rather see out their career years there than ever returning to work in their home country. Many other developed countries, such as the US, UAE, Australia, and Canada, have also sustained their high population-to-physician ratio by employing foreign-trained doctors from developing countries, including sub-Saharan Africa, where there is the highest shortage.

This is another area where Africa loses greatly to these developed countries where its medical experts migrate to in droves. It is estimated that African nations spend between $21,000 and $59,000 to train each doctor. A 2011 study found that nine sub-Saharan African countries, including Ethiopia, Kenya, Malawi, and Nigeria, suffered an estimated loss of $2.1 billion from investments for all their physicians working abroad. Watching these professionals ply their trade overseas indicates a huge loss to the entire continent and a great financial gain to other countries. The study also showed that the financial benefits to the UK amounted to $2.7 billion, $846 million to the United States, $621 million to Australia and $384 million to Canada.

• High Out-of-Pocket Cost of Medical Care

The lack of adequate funding makes Africans living in Africa grapple with a high cost of medical services, considering the high poverty rate in the continent. According to a 2016 report, more than 37% of all Africa’s health spending is from out-of-pocket payments. Given the low-income status of most African countries, this situation puts a dire financial burden on many households. Findings show that at least 11% of people experience catastrophic healthcare spending yearly, and 38% delay or forgo healthcare needs due to high costs.

The Way Out

For the continent to experience a transformation in its healthcare, African leaders need to lead by example and start using the country’s medical system. This will go a long way in building their citizen’s confidence in the system. Lawmakers across the continent may also need to enact laws ending the use of taxpayer money for medical tourism by leaders. They shouldn’t stop at making the laws; they should also enforce them diligently. Also, African-trained medical professionals must be encouraged to ply their trade at home. This can be achieved by putting in place improved remunerations and favourable working condition. Lastly, it’s high time Africa’s healthcare experienced a massive investment to bridge the system’s year-long funding gap. While private sectors and donors have made significant contributions over the years, governments across the continent need to also start playing their parts effectively.

About the Author

Olusegun Akinfenwa is a political correspondent for Immigration News, a news organization affiliated with Immigration Advice Service London. IAS is a leading UK immigration law firm that helps people migrate and settle in the UK.