Could this COVID-19 quagmire, complicated by the massive physicians brain drain that has become a norm and the mostly dysfunctional health centres in Nigeria, be a critical juncture for revamping the Nigerian healthcare system? YES, I think so. Especially if we take it as a national, communal and selfless (and even if selfish) mission.

Acemoglu and Robinson, while discussing the origins of power, prosperity and poverty in their book, Why Nations Fail highlighted the role of institutional drift and critical junctures in the political and economic change dynamics of countries. Critical junctures are major events that disrupt existing political and economic balance in one or many societies.
In 1346, the Bubonic plague caused the deaths of nearly half the populations of the Western and Eastern European countries it ravaged. It served as a critical juncture for the Western European countries as the ensuing massive labour force scarcity brought down the prevalent feudal order of the day to its knees. The successive events led to a switch to an inclusive institutional growth of those countries, in contradistinction to the extractive institutions of Eastern European nations.

Recently we had recurrences of Lassa fever locally and the Ebola epidemic regionally, but the COVID-19 appears the mother of all. Coronavirus disease (COVID-19), which started in Wuhan city of China in December 2019 has become a pandemic. It now affects more than 200 countries and territories (Nigeria inclusive), has infected more than one million people, with a death toll of more than 50,000 people across the globe. It wrecks its havoc on a geometrical scale, unmindful of technology, sophistication and worldly might. China, Italy, Spain, Iran, South Korea and and lately the United States have borne the hardest brunt of the disease.

Although, Africa is disproportionately affected, the director general of the World Health Organisation (WHO) called on the continent to brace up for the epidemic. Already there are travel restrictions all over the world and Nigeria has closed down all its airports to international flights, while states are blocking entry and exits with the propensity towards a total lockdown.

The Nigerian healthcare system has an historical past glory, as it was once at par with that of many countries that are now our medical tourism hotspot destinations. It is on record that some decades ago, the Saudi royals were visiting University College Hospital, Ibadan on medical tourism. And while the first conventional Open Heart Surgery in the world was conducted in 1953, it took Nigeria only two decades to catch up in 1974. But suddenly and rather unfortunately, the difference between our healthcare system and that of the developed world seems world apart.

The major challenges facing healthcare in Nigeria are inadequate human resources, infrastructure, equipment and the lack of a robust system. This led to the dwindling of health indices and massive medical tourism outside the country by the few who can afford it.

Currently, there are less than 50,000 physicians working in Nigeria, mostly in the cities, for a population of 200 million. The same applies to other healthcare workers. There is an estimated gap of 260,000 additional physicians to meet the World Health Organisation’s physician to patient standard ratio. This would require Nigeria to produce at least 10,000 physicians annually, who must stay and work locally. The production capacity of physicians in Nigeria hangs at around 3,000 yearly.

The brain drain of physicians has been a known phenomenon since after the world wars when European experts started migrating to the United states. There are both push and pull factors that encourage this brain drain. Nigeria is currently facing one of the greatest exodus of physicians of all cadre to other parts of the world and the same applies to other healthcare workers. About two thousand physicians are estimated to be migrating and or planning to migrate outside the shores of the country annually. This creates a huge professional gap, which further compromises the state of the Nigerian healthcare system. Hence, access to basic and advanced healthcare in Nigeria for both the poor and the rich is severely restricted.

Medical tourism has become a big industry for some countries, with an estimated $1 billion spent on this by Nigerians annually. The commonest healthcare needs being sought after are treatments for cardiovascular diseases (heart and blood vessel diseases), cancers and kidney diseases, as well as other forms of diseases. These services are not readily available in Nigeria and many patients are either suffering or dying from them, with consequent huge socioeconomic repercussions on families and the nation.

Is Medical Tourism A Sustainable Option?

For the affluent, it could be sustainable so far as their wealth subsists and the gateway remains accessible, but for the vast majority who are either starkly or marginally poor, this is not even an option, not to talk of its sustainability. Even for the affluent, it is only feasible for elective health cases that can wait for some weeks or months to be treated. For emergency cases, the reality is that one might not have the luxury of jetting out for medical tourism. Heart attack, which is becoming common, requires no more than 90 minutes from its occurrence to when treatment procedures are performed in order to avert death. When it strikes here, the most likely outcome is death, since the diagnostic and treatment services are seldom available.

What will be more devastating than an affordable life-saving treatment that becomes a mirage just because it is not available?

Someone says, ‘the best Hospital is the hospital closest to you’ and ‘the best doctor is the doctor closest to you’ when you dearly need them and not the ones in the U.S.A, Germany, Saudi, Egypt or India.

Many patients (albeit affluent), are currently trapped in the cobweb of being unable to travel due to COVID-19 restrictions and are forced to utilise the poorly developed health facilitiesin the country to their chagrin. Victims of COVID-19 face the same predicament. Even the foreign physicians who come for medical missions in some select hospitals are unable to come presently. Now, we are all at risk and vulnerable notwithstanding our socioeconomic class or the positions we hold. We are all in it together; a sort of a de-facto comradeship.

For how long, how frequent and at what cost can this be tolerated? Let us all remember that there is only one life we are proud of for ourselves, families and all loved ones and this is now at risk of being wasted with the blink of an eye.

Could this COVID-19 quagmire, complicated by the massive physicians brain drain that has become a norm and the mostly dysfunctional health centres in Nigeria, be a critical juncture for revamping the Nigerian healthcare system? YES, I think so. Especially if we take it as a national, communal and selfless (and even if selfish) mission. The Nigerian healthcare system needs to be face-lifted in all ramifications to save our dear individual lives, those of our loved ones, our pride and pockets.

Does it ring a bell that a third of the $1 billion that Nigerians spend annually on medical tourism can comfortably be able to establish one heart centre, one kidney centre and one cancer centre for each of the six geopolitical zones in Nigeria? Thus, can create 18 new centres of excellence with a potential for stopping and reversing medical tourism. This amount will cover infrastructure, equipment, training, collaboration with other centres of excellence in developed countries and still be able to offer free sophisticated procedures, such as open heart surgery and kidney transplants to at least 500 patients for each centre. We just need some doses of priority, probity and an obsession with posterity from government and other stakeholders.

For us to use the COVID-19 and its consequences as a critical juncture and avoid being caught in the quandary again, there is need for sincere commitment to revamp the Nigerian health care system by all and sundry.

Apart from what governments currently do for the healthcare system, I advise the following:

1. The federal government, in collaboration with philanthropists and corporate bodies, should launch a special three year quaternary healthcare plan (2021-2023) in which two state-of-the-art heart, kidney and cancer centres will be fully established yearly in the six geopolitical zones alternatively, so that by 2023 each zone will have at least each of those three centres. This will go a long way in reducing or even reversing medical tourism, especially for the lower and middle class. If per adventure (although not praying for this) a similar or a different travel ban arises in the future, the upper class can also utilise these services.

2. The federal government should form a special committee to understudy the extent and impact of the brain drain of physicians and other health workers with a view to understanding the push and pull factors involved in this and to offer realistic solutions. A sustainable strategy for brain-gain and brain circulation of diaspora Nigerian medical experts should be designed.

3. The federal and state governments should liaise with the Nigerian Universities Commission (NUC) and regulatory agencies, such as Medical and Dental Council of Nigeria (MDCN) to provide the requirements for increasing the enrolment and graduation of physicians, nurses, pharmacists, medical laboratory scientists etc. in federal and state universities and other institutions.

4. The federal government should encourage medical entrepreneurs (medipreneurs) to establish standard private hospitals, medical universities and medically-related manufacturing industries, through soft loans, special interventions and ease of doing business via the Central Bank of Nigeria (CBN), Bank of Industry (BOI), Development Bank of Nigeria (DBN), as obtained in countries like India.

5. A special fund should be dedicated to support the treatment of cardiovascular diseases, kidney diseases and cancer for indigent patients.

6. The National Health Insurance scheme should cover cardiovascular diseases, kidney diseases and cancer treatments and more states should hasten to commence a form of health insurance scheme.

7. Healthcare workers need to be more dedicated to their work with sympathy, empathy and selflessness, while the government should reciprocate the gesture through the provision of incentives and welfare packages.

8. The legislature being representative of the people should ensure the above suggestions are initiated and perform the oversight functions on their implementation.

9. The electorates and civil liberty organisations should ask and advocate for improved basic and advanced healthcare from elected leaders as a fundamental human right.

Availability of state-of-the-art healthcare services in any country is a necessity, especially for the not so financially endowed citizens at all times. The financially buoyant citizens also need such services during emergencies and when situations are not favourable to fly out, such as during the present COVID-19 pandemic.

I pray that the spread of coronavirus disease be contained in earnest, the afflicted be healed and the minds and will of our leaders and us be directed to revamping the healthcare system in Nigeria when the pandemic fizzles.

Jameel Ismail Ahmad wrote from Kano.