Medical tourism and national devt: Implication for the health sector

Dr. Longwap AbdulAziz Saleh

Over the years, various kinds of tourism, ranging from eco-tourism and heritage tourism to agro-tourism, have come into existence. The latest addition is medical tourism.

The World Health Organization define health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, health tourism is the broadest of all possible categories of health-related activity that involves travel. In other words, medical tourism is a subset of health tourism. The term medical tourism has come to embrace all facets of consumers seeking treatment, improvement or change through medical or wellness practices provided they cross an international border to do so. ‘Medical tourism’ is originally a term used to qualify a patient’s movement from highly developed nations to other areas of the world to get medical treatment, usually at a lower cost. More recently, however, the term is being generally used to mean every form of travel from one country to another in search of medical help, which can also simply be called ‘medical travel’. It also includes traveling to countries where treatments for particular conditions are better understood.

In Nigeria, in the year 1970s and 80s, almost every hospital in Nigeria had an Indian doctor. The reasons are obvious. Then, the Nigerian economy was seemingly stable enough to support the subsistence of these medical experts at a time the country lacked enough human resources in health.

The hospitals were fitted with basic amenities that helped these Indians, with support from the few local doctors then, to do exploits that looked like they had powers from other sources.

The story, however, started changing in the late 1980s, and by the late 1990s, it had reversed. The Indian High Commissioner to Nigeria, MaseshSachdev, gave credence to this reversed development when he said, “While a large number of Indian Medical professionals served here (Nigeria) during 1970s and 80s, most have returned.”

Sachdev summed the obvious consequence of this reversed trend thus; “The past four years have witnessed a steady rise in Nigerian patients travelling to India for medical interventions.”

The typical processis as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified physicians or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient’s accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

a. For specialized procedures in-vitro fertilization, surrogate pregnancy and orthopaedic procedures like hip replacement.

b. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care, e.g war and political instability.

c. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. Lacked enough human resources in health. Number of Doctors is not proportionately enough compared to our population and majority are in the cities.

d. Other factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

e. Lack of medical equipment. Medical equipment in some hospitals is bedeviled with irregular maintenance and upgrades, and diagnostic services not readily within reach, raising questions of quality control, availability, timeliness and reliability.

f. Low standards of patient care, an absence of world-class hospitals and diagnostic centres and the stunted growth of the healthcare system in the country.

g. A poor pipeline for high skills, poor health value chain, as well as low health insurance cover, have led to weak effective demand for healthcare services, resulting in poor economics of scale for hospital services in the country.

h. There is poor management, plus poor staffing in terms of number and specialties of doctors and other healthcare providers. These have resulted in the low standard of care in the country.

In the year 2012, 47 percent of Nigerians visiting India to get medical attention, while the remaining 53 percent did so for other reasons according to Business Day Nigeria. The 47 percent of Nigerians who visited India for medical purposes amounted to 18,000 persons and they expended N41.6 billion ($260 million) in scarce foreign exchange in the process. These figures were primarily released by the Indian High Commission.

Is it safe?

Among the medical risks patients face when having major surgery performed outside the United States are infectious diseases not found in more developed countries. Nations such as India, Thailand, Malaysia, and Costa Rica have a higher incidence of tuberculosis, hepatitis A, amoebic dysentery, and other diseases than the United States. These pathogens present a real threat to a person having a major surgical procedure, whose immune system is unaccustomed to them.

A patient who is injured through negligent care has very limited options in obtaining justice and compensation. With different laws in other nations, the legal alternatives for patients are few. In his book on medical tourism, Beauty From Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S., Jeff Schult states “My sort of blunt advice is that if your primary concern in going to a doctor, surgeon or dentist is whether or not you’re going to have legal recourse if you don’t like the work you get, you shouldn’t go overseas.”

Medical liability laws also vary significantly among countries. Patients who are considering elective surgery abroad should not assume that they will be afforded the same legal protections against medical negligence as they receive in the United States or India.

a. Develop private sector healthcare. There is need to improve access to capital, develop and enforce quality standards, mobilise public and donor money to the private sector, modify local policies and regulations to foster the role of the private sector.

b. The Federal Ministry of Health will look at regulations to discourage growth of medical tourism and review fiscal policies (economic incentives, tax, foreign exchange, import tariffs) that affect healthcare, to create more favourable economic incentives for doing business in the healthcare sector.

c. Foster health insurance to cover more specialized proceedures to help maintain standard and speed of health care delivery.

d. Creating an enabling environment for the health sector to grow. The health sector just like any other sector need basic infrastructural facilities such as good road, electricity, housing and water to grow.

e. Encourage collaborative medical services like the one done in Port Harcourt were a top Indian hospital sealed a deal to set up collaborative medical services in Port Harcourt, Rivers State, at the First Rivers Hospital. Medical cases can be properly examined and successfully managed in Nigeria without the extra burden of overseas travels while local Doctors upgrade their skill.

f. Nigeria can set up a gigantic plan to build at least one mega hospitals in each of the six geo-political zones of the country soon, as a way of responding to the health challenges of the country.

Role/Effort of the Nigerian Government

On the basis that medical tourism is just another form of tourism, and healthcare should be regulated in the same way for locals and visitors, many claim that there is no need for medical tourism regulation. But the medical tourist has chosen the country and hospital, often on far from perfect information, and once they leave, would have difficulty doing anything against those who may have served them badly.

• Should government just enact basic medical tourism regulations?

• Should it decide which hospitals and doctors can offer medical tourism?

• Should it regulate agencies and if so what does it do about overseas agencies?

• Is a better approach to help selected hospitals with marketing and sales?

• What do you do with people and organizations that break the rules?

In a report, the Federal Ministry of Health alluded to the fact that, the human development indices for Nigeria were among the worst in the world. Nigeria shoulders 10 % of the global disease burden and is making slow progress towards achieving the 2015 target for the MDGs on healthcare.

However, the national strategic plan, which hopes to strengthen the national health system and to vastly improve the health status of Nigerians, estimates that a total amount of N3.99 trillion (US$26.6 billion) would be required to reposition the Nigerian health system over the next six years.

Just the same, the National Health Insurance Scheme (NHIS) conceived to provide medical coverage for users under the scheme has only have 5 million enrolled. The NHIS has equally remained primarily an urban thing, a clear departure from its objective, which was to make primary healthcare accessible and affordable for all Nigerians. Experts say the lack of clear policy direction in healthcare delivery has hindered its expected progress. This should be properly reviewed to include those outside the public sector like market women.

The Nigerian local government says that with state population of 21 million, it is very difficult to meet the health needs of all Nigerians. So as well as existing state run hospitals, it seeks outside investors to help build new hospitals. We appreciate the partnership they have brought to us. We can now save our airfare, accommodation, the trouble of procuring visa and other expenses in India. We promise a good return on their investment.”

On a national basis the government is determined to curb outbound medical tourism. It hopes that perhaps within the next five years they will see people going to Nigeria for medical treatment. But small hospitals like this new family oriented healthcare facility will work for local care, rather than high-class medical tourism.

Well equipped Laboratories, Diagnostic centres, major investment in well equipped hospitals will always be tremendous assets with top of the range socio economic rating for a very long time to come.

NGOs may attract good funding for proposals in this direction as contribution to improving on the worrisome healthcare aggregate capacity in Nigeria.

In Singapore and Malaysia, the healthcare systems were previously mixed between public and private sectors. In both countries, people generally had access to affordable healthcare. However, future projections for the healthcare systems indicated limitations and governments in both countries considered medical tourism as a solution. Their timing was mostly based on financial downturns. On the back of extensive long-term healthcare reforms, today both countries enjoy success in medical tourism driven by government incentives and initiatives. These emerging markets initially experienced capacity shortfalls in their healthcare systems at some point in the past, but their medical tourism incentive did not compromise their existing medical care entitlements.

For any comments, questions or contributions, you can contact me via my email address or blog as stated bellow.

Dr. Saleh, MBBS, PGDPA, is a medical officer, Special Task Force Jos. He can be reached via:,


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