Medical tourism is now very popular. I frequently receive crowd-funding drive messages for ill individuals seeking medical intervention in India especially. I am quite certain that this is something a lot of people can relate with. You probably know someone who knows someone who has either gone or is planning to go to India for a medical procedure.
Medical tourism is an unfortunate trend that reflects a more systemic problem with the Nigerian state. It makes me wonder just how long this ugly phenomenon would continue before we decide enough is enough. Given that we have unforgivably decimated our healthcare system to its current decrepit state, we have created an infinite clientele pool for more serious countries like India. You see, Nature abhors any form of vacuum and will therefore provide supply somehow so long the demand persists. This is how things work. Medical tourism is a win for India.
We have a lot in common with India interestingly. They are only a few places ahead of us in the list of the world’s most populated nations. I also imagine that they are only marginally ahead of us in terms of intellect. What we lack is vision and the organisation to put our house in order.
The local market for healthcare in India is huge with a population of over a billion and the country is even projected to unseat China by 2050 as the country with the highest population in the world. But they have not relented in their drive to capture international market share from countries that lack the requisite infrastructure, manpower, and milieu to deliver the highest standard of health care. Their relatively affordable pricing also ensures they are able to out muscle competitors like the United States and the United Kingdom in attracting patients.
Nigeria has been a very viable market for the Indians. We love that country so much that it is estimated that the country’s High Commission in Nigeria issues approximately 40 medical visas on a daily basis. There are five working days in every week so please do the maths. In 2011, only 5,000 of the 25,000 Indian visas issued were not for medical procedures and in 2012, 18,000 visas were granted based on medical grounds. As a matter of fact, half of all Nigerians who travel abroad for medical reasons go to India for care.
In monetary terms, Nigerians spent $260 million in 2012 alone in India meaning an average of $15,000 per head. One Nigerian Medical Association report suggests that the annual figure lost could be close to $500 million. In these days of scarce forex, imagine what these sums would do to our local economy! Medical tourism is a Loss for Nigeria!
The Indians are smart. There is something called the No Obligation to Return to India (NORI) certificate. The government issues this to its medical practitioners who undertake trainings and exchange programmes in more developed nations like the U.S. Essentially, it is a tool the government has designed to stem brain drain such that Indian doctors may find it harder to migrate abroad since the host countries will require this certificate to engage such doctors in their system. So no NORI certificate, no work for you. This helps the country keep its best and the sector is better for it.
Medical tourism contributes approximately 6% of India’s Gross Domestic Product (GDP) and was estimated to be a $3 billion industry in 2015. It is projected to contribute 25% of the nation’s GDP in the next 5 years when it would be worth over $7 billion. Do you now understand why there has been a flurry of Indian healthcare adverts on digital media targeted at Nigerians? The Indians are taking this cash cow quite seriously. And they should.
The retention of their best hands even after foreign trainings means they are able to undertake meaningful research and develop relevant technology locally. They have succeeded in bolstering almost every element of the value chain by using medical tourism as leverage. Imagine that in fourteen years, the nation’s pharmaceutical exports to Africa grew from just about $250 million to $3.5 billion.
The country’s tourism sector vis-à-vis hospitality has experienced remarkable growth as medical tourists pour in (medical tourism is a huge market for India). These medical tourists will have to stay somewhere and are unlikely to come alone, at least one relative will accompany them on the trip. They will also eat and buy consumables from local sellers. See the paper trail? This is how the money will keep changing hands and an economy will remain buoyant.
The Dubai Healthcare City was inaugurated in 2002 and sits on over 4 million square feet of land. Year on year, the place experiences higher numbers of visitors and is gradually changing the face of healthcare delivery in that region. Unsurprisingly, Nigerians are not left behind here also. The government of the United Arab Emirates, has ingenuously developed this free economic zone with mouth-watering tax incentives allowing private businesses invest massively in the revolution going on in that place.
Of course, it was worth it for the government! A second phase of the city which is primarily wellness-based is now ongoing and will sit on an unbelievable 19 million square feet expanse. It was easy to trust the government given the masterpiece they had created in Dubai. They had shown that massive infrastructural development was the key first step to attracting investors and this is a salient lesson that must not be lost on any Nigerian government. The rate-limiting step is always political will.
Strategic alliances are the way to go as quick wins. They have already started but must be accelerated and incentivised massively by the sitting government. The quicker the Nigerians can understudy their Indian counterparts the better. Unfortunately, we may not bring much to the table initially in terms of skillset and technology and so we may have to share profits even unequally at the teething stages.
Again, we must aim to develop relevant methods and technology locally like the Indian model that allows them carry out procedures at a tenth of what the Americans or British will normally bill for the same standard of care. This is particularly imperative given the socioeconomic status of the majority of Nigerians.
The Nigerian healthcare practitioners must also get on board. As it is, there is so much rancour in the ranks that one wonders where the rejuvenation will start. The sector is a mess and every member of that sector is culpable. Rather than fight over who heads the hospitals, which is often never altruistic anyway, or fight over how much the other person gets, they need to refocus and synergise for the greater good of their patients and the growth of their sector.
The government’s role is also critical in creating an environment for businesses to thrive. The current structure where it funds teaching hospitals is simply not sustainable, especially in the face of dwindling revenues. The growth must be private sector driven and government must essentially serve as a regulator as well as grant tax relief and other incentives that these private investors will jump at.
There are several Nigerian doctors in the diaspora excelling in different fields of clinical and non-clinical medicine. We stand a better chance of drawing them back if we get things right. We urgently need to fix power, improve security and develop extensive social amenities like roads and transport systems.
There is a lot of work to be done and the stakeholders must step up at such a critical time. Our hospitals are deplorable at the moment and the trend will only worsen with unfettered brain drain and lack of political will to stem the tide. Time, unfortunately, is not our friend. The time to start is now!
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