Strike: Doctors shun talks, medical tourism gulps $3bn in three years
17th May 2023
Dr Emeka Orji
President of the Nigerian Association of Resident Doctors of Nigeria, Dr Emeka Orji
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Nigerians spent about $3bn on foreign healthcare-related services from 2020 to 2022, according to findings by The PUNCH.
The total spending for the period under review was obtained from the Balance of Payments database of the Central Bank of Nigeria.
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This came to the fore on Tuesday as the Nigerian Association of Resident Doctors insisted on starting a warning strike on Wednesday.
The doctors are starting the strike despite the fact that the Federal Government said it had begun talks with their parent body, the Nigerian Medical Association.
As doctors cited poor health infrastructure as one of the reasons for the strike, The PUNCH observed that Nigerians spent a total of $7.07bn on overseas treatments between 2016 and 2022.
The least bill for medical tourism was in 2016 (about $17m) while the highest amount was spent in 2019 ($2.56bn).
About $783.77m was spent in 2017, while about $1.67bn was spent in 2018.
The data further showed that over $1bn, $615.03m, and $434.43m were spent in 2020, 2021, and 2022, respectively.
Despite a steady decline since 2019, which was the peak of Nigeria’s foreign health spending, the amount spent rose by 2,455.47 per cent between 2016 and 2023.
This occurred amid crises in the health sector and the President, Major General Muhammadu, and many other politicians’ penchant for foreign medical trips.
Although it is unclear how much has been spent on the President’s check-ups, the Buhari regime has earmarked at least N33.3bn for the State House medical infrastructure in the past eight years.
This includes recurrent items such as the “purchase of health/medical equipment, drugs and medical supplies” and capital components such as the construction of the presidential wing of the State House Medical Centre scheduled for completion this month.
State House hospital
A breakdown of budget documents for the period under review revealed that general “medical expenses” gulped N308.26m; the State House Medical Centre took N8.35bn, while the presidential wing gulped N24.24bn.
The President presented the 2023 appropriation bill to a joint session of the National Assembly in Abuja on Friday, October 7, 2022, his last.
In 2016, the State House medical budget stood at N4.84bn. In 2017, N384.76m was allocated for medical expenses and operation of the facility.
A total of N1.08bn and N850.68m were allocated in 2018 and 2019, respectively. This dropped to N634.14m in 2020.
In the 2021, 2022 and 2023 budget proposals, N693.01m, N708.75m and N476.52m, respectively, were allocated to the State House Medical Centre and medical expenses.
However, the document did not reveal how much the regime spent on the President and Vice-President’s medical treatments and check-ups in the past eight years.
But a closer examination of the appropriation bills revealed that the State House earmarked N744.85m for “drugs and medical supplies” alone within that period.
On the capital expenditure side, the Federal Government budgeted N723.72m for various phases of the “completion of dental wing extension in the SHMC and outstanding liabilities on reclamation and earth filling.”
Since 2019, successive appropriation bills also allocated a total of N24.24bn for the “construction of the presidential wing at the State House Medical Centre.”
The breakdown is as follows: N395.83m (2019), N416.67m (2020), N1.06bn (2021), N21.97bn (2022) and N393.66m (2023).
The State House Medical Centre has been allocated N9.67bn while the Federal Ministry of Health has been allocated about N4.04tn from 2016 to 2023.
In 2016, the Ministry of Health received N250bn, while in 2017, N304.1bn was allocated.
The 2018 budget indicated that the ministry had N356.4bn, while in 2019, N372.7bn went to the ministry.
In 2020, N414.4bn was budgeted for health and the 2021 budget allocated N549.8bn to the Ministry of Health.
The President allocated N1.08tn to the Ministry of Health. Compared to the previous year, the health sector budget increased from 714bn. However, the N1.08tn only accounts for 4.93 per cent of the total budget. This is significantly less than the benchmark of the World Health Organization to allocate at least 15 per cent of the annual national budget to health.
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The standard of healthcare in the country has been questioned over the years citing underfunding as a major factor, causing several Nigerian doctors to migrate to other developed countries.
A bill seeking to prescribe a jail term of seven years and, or a fine of N500m narrowly passed second reading at the House of Representatives in February last year.
Sponsored by Sergius Ogun (Peoples Democratic Party/Edo), the legislation is titled ‘A Bill for an Act to Amend the National Health Act, 2014; and for Related Matters.’
Leading the debate on the bill, Ogun noted that the objective of the proposal was to amend the Act “so as to make provision for sanctions against any public officer who violates the provisions of the Act, especially Section 46 of the Act.
The section reads, ‘Without prejudice to the right of any Nigerian to seek check-up, investigation or treatment anywhere within and outside Nigeria, no public officer of the Government of the Federation or any part thereof shall be sponsored for a check-up, investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation and referral shall be duly approved by the Minister or Commissioner of Health of the state as the case may be.’
Ogun said, “This bill, which seeks to amend the National Health Act, is borne out of a desire to discourage medical treatment abroad at the detriment of our indigenous health institutions. The need to revamp the poor state of the healthcare sector in Nigeria, among other things, is the reason for introducing this bill.
“It is no news that Nigeria’s health care system is in a deplorable state and needs urgent attention. There is a paucity of infrastructure, a dearth of medical personnel, poor standards and many other challenges that need to be addressed. The intent of this bill is to spur public officers to pay more attention to our health care sector and take drastic steps to develop and improve on the sector.”
The lawmaker urged members of the House to look at the merits of the bill and let it pass “in the interest of our nation, which is currently going through trying times and requires drastic steps to bring it back on its footing.”
Ogun listed the merits of the bill to include a reduction of the mass exodus of doctors from Nigeria to other countries.
“If this House passes this bill into law, it will curtail the excessive medical trips of public officers abroad and direct their attention to fixing the poor state of the country’s health sector. This will in turn lead to the development of the health sector, and improved remuneration for medical Doctors, thus attracting Nigerian doctors abroad to come back home,” he said.”
NARD kicks
The President of the Nigerian Association of Resident Doctors, Dr Emeka Orji, said that politicians and the rich who lacked faith in Nigeria’s health system were the reasons for the high amount spent on medical tourism.
He said, “The thing aiding medical tourism is because politicians and those well-to-do do not believe in our health system.
“So, they choose to go outside of the country and that is why they have not been able to upgrade the hospitals to international standards. If we are all using the same health facilities, the situation would have been better.”
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He also urged politicians to patronise Nigerian hospitals to understand the condition of health facilities and fix hospitals.
Orji said, “Our politicians and other government officials should patronise our hospitals in the country. It is only when they do that they will know the condition of the healthcare facilities and do what they can to fix the hospitals. It is only when the doctors determine that it is something they cannot handle that they can be referred accordingly.
“We have not done the study to know the amount of taxpayers’ money involved in medical tourism, but we have been advocating that the President and other political office holders should instil confidence in the system by patronising Nigerian hospitals and our local health facilities.”
He further stressed the need to fund the health sector, increase budgetary allocation and improve manpower for things to get better in the country.
‘Address brain drain’
The National President, Association of Nigerian Private Medical Practitioners, Dr Kayode Adesola, urged the government to address the issue of doctors’ migration and improve health infrastructure in the country.
He said, “There have been a lot of seminars and plans regarding the reversal of medical tourism but all those efforts have been at the preparatory stage.
“The government needs to sit up; the government must address the issue of doctors’ migration. Whatever remuneration is needed, we have to act like serious people and ensure that we sustain essential services and appreciate our doctors.
“We need to improve infrastructure in the health sector. We need to have the needed infrastructure and there should be the full implementation of the National Health Act that was promulgated in 2014. The budgetary allocation for health must be increased to at least 15 per cent.”
Adesola further urged the president to lead by example and stay back for medical treatment in Nigerian hospitals.
A former President of the Nigerian Medical Association, Prof Mike Ogirima, on his part criticised any government official spending public funds on medical tourism.
He described this act as corruption, noting that Nigeria has enough competent hands.
Ogirima said, “The factors aiding medical tourism range from personal desire and the ability to foot the bill, but I’d course, there is corruption there because for government officials spending public funds for medical tourism is part of the corruption we are saying.
“Gone are the days when non-availability of qualified hands to handle medical issues; we have qualified hands now, and we are handling them now. Apart from them, our doctors who travel out of the country as a result of brain drain are coming back to offer skilful services to complement the ones trained locally. Those of us that are here have also improved our capacity by updating our skills.”
But the Director of the Centre for Promotion of Private Enterprise, Dr Muda Yusuf, in his submission noted that the figures spent on medical tourism showed the unfortunate absence of good governance at both the federal and state levels in the country over the years.
Muda, who recalled years when the country attracted medical tourists, said the current situation is caused by a lack of investment in the health sector.
He said, “It is very unfortunate that this is our current situation. It is due to the fact that we have neglected to invest in our health sector.
“In the 70s, other countries were coming to Nigeria for medical tourism, but now the reverse is the case, and I think it is part of the failure of governance that we have witnessed in the country over the years. Because if we had invested well in our hospitals, then there will be no need to spend this amount of money even though a few cases may still be referred abroad, at least for those who can afford it but the situation will not be this bad.
“It is part of the failure of our governance and this is both a federal and state issue because they both contribute to the issue and should be held responsible for their failures.”
He further stressed that the situation can only be changed through policies, incentives and investments by the private sector.
On his part, a Professor of Economics, Sheriffdeen Tella, stated that the absence of regulations limiting medical tourism has made it easy for public officials to get foreign treatment unabated.
He added that investments in the sector remain the only solution to curb the menace adding that politicians can only be appealed to in order to reduce the amount of forex spent on medical tourism.
He said, “There are some top-notch facilities in the country that does not require travelling abroad or sourcing for forex. But our politicians are bent on travelling because it is not their funds, which is quite unfortunate.
“There are many people who have serious health challenges and are surviving from treatment received here, but since there are no laws that compel them to have their treatment here so we can only appeal to fund the health sector well so that we can save our forex.”
“There is also a need to increase the budget for the health sector locally and make sure the sector is vibrant,” he added.
Meanwhile, about 12,000 members of the NARD across 79 tertiary health institutions in the country, who formed the backbone of the healthcare sector, will commence a five-day warning strike at 8 am today (Wednesday).
NARD said the warning strike would end on Monday, May 22.
The resident doctors had, on April 29, 2023, issued a two-week ultimatum to the Federal Government to meet their demands or face industrial disharmony.
The ultimatum lapsed on Saturday, May 13.
The doctors are demanding an immediate increment in the Consolidated Medical Salary Structure to the tune of 200 per cent of the current gross salaries of doctors.
The doctors also want immediate massive recruitment of clinical staff in the hospitals, and immediate withdrawal of the bill seeking to compel medical and dental graduates to render five-year compulsory services in Nigeria before being granted full licences to practise.
They also want the immediate implementation of CONMESS, domestication of the Medical Residency Training Act, and review of hazard allowance by all the state governments as well as private tertiary health institutions where any form of residency training is done, among others.
Meanwhile, the Minister of Labour and Employment, Chris Ngige, had on Monday, during the Federal Executive Council meeting in Abuja, described the NARD warning strike as unnecessary since the government was already engaging with the Nigerian Medical Association.
The minister said, “On the demand for a 200 per cent salary increase, the NMA is the father of all doctors in Nigeria, and they have about four or five affiliates of which the resident doctors are an association. So, the NMA is discussing with the Federal Ministry of Health, Salaries Income and Wages Commission, and the Ministry of Labour, and we know that the NMA has accepted a salary increase of between 25 and 30 per cent across the board for their members.
“So, I don’t know the logic by which people who are members of the NMA are now coming up to say pay us 200 per cent increase. I don’t understand it. I have called the NMA President to contact them because, on the issue of remuneration negotiation, it’s the NMA that the government deals with. So, I have told the president of the NMA to contact them, and we will engage them. They should not go on any strike, it’s not necessary,” Ngige said.
But speaking in an interview with The PUNCH on Tuesday, the President of NARD, Dr Emeka Orji, said, “What we are asking for is not for the doctors but for the health system in general, because if we do not address these issues, the problems we are having in the sector will continue to happen and it will get to a time when there will be a total collapse of the system.
“Doctors are leaving in droves, clinical staff are leaving and we have always said that the most important cause of the brain drain in the sector is poor remuneration. We have even done a study on this, and we have said this over and over again. If we do not address these issues, it will come to a point when we will not even have nurses to attend to patients.
“Politicians and associates who are well-to-do will leave us here and go out to seek health care services outside of the country, the poor masses on the street cannot afford to do that. What we are doing is to call the attention of the government to act and request that they address the issues so that they can stay in the country to serve the country.”
Asked if the NMA and the Medical and Dental Consultants Association of Nigeria were in support of the NARD strike, Orji said, “We do not have official evidence that they are against the strike. The government should wade in and solve what they can solve and give timelines for the ones they are yet to do but, there has not been anything from them.
“We have a President-elect, we know that he is watching, and people are watching. It may not be good for them to take over when there is a crisis in the health sector, and that was why we have to restrain our people to continue to exercise patience.”
Orji called on the government to address the issues raised before the May 29 handover date as further industrial harmony could not be guaranteed after the warning strike, should the issues be left unresolved.
“All options are on the table when we meet, including indefinite strike action… after the warning strike should the issues be left unresolved,” he said.