Our beautiful daughter was born in
August 2009 and weighed 3.4kg. No abnormalities were discovered at birth.
However, at 4 weeks of age, we noticed bluish discoloration of her inner lips,
sweating while breastfeeding, poor feeding, weight loss and failure to thrive.
After a series of investigations which included echocardiography, it seemed
certain that she had been born with congenital heart defects (“holes in the heart”). However, we received conflicting diagnoses from a tertiary medical centre and a private diagnostic centre both in Abuja. To say we were worried would be the understatement of the century!! Subsequently, the Paediatric Cardiologist at the government tertiary medical centre in Abuja referred our daughter to MIOT hospital, Chennai, India. At MIOT, the definitive diagnosis was different from both diagnoses we received in Nigeria. The Indian Paediatric Cardiac Surgeon successfully performed an Arterial Switch Operation which closed the defects. Our daughter is now fine and her energy sometimes makes me wonder if perhaps she was given two hearts in India.
I am
sharing my family’s medical challenge to demonstrate our experience of
Nigeria’s fast growing medical tourism to India industry. Over the last few
years, medical facilities in India have become increasingly aggressive in
marketing their services to clients across the globe. The dearth of standard
healthcare facilities/services, the poor governance of clinical practice and
the lack of confidence of the people in the care available in Nigeria makes it
a ready market for Indian hospital groups. The Indian economy benefits not just
from the cost of the healthcare provided but also the ancillary services of
accommodation and welfare of accompanying relatives. The Nigerian Medical
Association estimates that over 5000
Nigerians travel to India and other countries monthly for medical treatment
leading to capital flight of $500 million annually. It’s anyone’s guess the
impact an annual investment of $500 million would have on Nigeria’s healthcare
industry. To put it in perspective, that sum was approximately a third of Nigeria’s entire
federal health budget for 2013.
The aggression in marketing medical
tourism to India, targeting Nigerian doctors has more recently taken on a
worrying dimension. While in the past, many Indian healthcare facilities had
focused on advertising discreetly to Nigerian doctors and directly to Nigerian
patients in the newspapers, a more ethically dubious model is emerging. It is
time to question the ethics and economics of this type of marketing and its
impact on the Nigerian healthcare industry. For example, an Indian medical
group openly operates an incentive-based patient referral program. This program
promises earnings of “$1000 by simply referring
patients” and “10% referral fee when patient’s trip to India is finalized”. It
implies that for a patient whose medical procedure costs $10,000, the referring
Doctor will receive a “commission” of $2,000 just for the referral, creating a
perverse incentive. That is a huge amount in a country where Doctors’ salaries
are abysmally low. With this kind of incentive, what is to stop unethical
doctors from referring their patients to India even when such an action is
unnecessary or sometimes potentially harmful?
There have also been anecdotal
reports of Indian hospitals coming to Nigeria directly to solicit for patients
through their own clinics and facilities set up largely for that sole purpose.
Economically, for patients and their
families, paying for treatment in India does not come cheap. Nine of every 10 Nigerians survive on less than
US$2 a day, it is not surprising that most people have to seek significant cash
donations and loans in order to pay for medical treatment in India. Even, as a
doctor myself; my wife and I still had to take loans amounting to thousands of
dollars from both of our employers to pay for our daughter’s surgery.
In my case, and for several other
Nigerians that have successfully raised the funds for medical treatment in
India, this has been life-saving.
However there are several questions
that arise; is it ethical for Indian hospital groups to market health services
this way through Nigerian doctors? Is it legal for Nigerian doctors to accept
financial incentives for referral without declaring this to their patients? Is
it fair that Nigerian Doctors/hospital groups are not allowed to advertise
their services locally while their counterparts from India brazenly do so?
However, the biggest question is why
the Nigerian healthcare sector is not responding rapidly enough to the huge
demand for high quality, well managed, ethical and financially sustainable
medical services.
For a long time, governments at all
levels in Nigeria have failed to implement policies to drive the improvement of
health services. Despite the often acclaimed projects to
equip hospitals, very little has changed and there is little confidence in
health care services offered in Nigeria. Even in the private sector, the story
is not much different. It is time for some game changing investments in the
Nigerian health industry. Investors can take a cue from Africa’s richest man,
Aliko Dangote, who is investing in the construction of a 1000-bed ultra-modern hospital
in Kano State. He should be encouraged to make the proposed hospital a centre
of excellence focusing on few specialties. Kano could as well become a medical
tourism destination; patients from other parts of Nigeria, the West African
sub-region and Africa as a whole should benefit from the hospital if it is well
organised and equipped. In starting off, he must learn from previous attempts
to set up ultra-modern hospitals in Nigeria and understand why they failed
While the equipment and clinical
expertise may appear like a tough problem to solve, they are actually the
relatively easy ones. Until we find a financial model that works for the poor
and the middle class, one not based on a fee-for-service model, it is unlikely
that any investment in the health sector will be sustainable. Strengthening
primary care and efforts at prevention will also be essential.
Nigeria is now the largest economy
and has the largest population in Africa. These positives should translate into
better healthcare for all Nigerians. We really have no business travelling thousands
of miles to India for healthcare. For us at Nigeria Health Watch – We will
celebrate when Nigeria becomes a health tourism
destination. Until then….there’s work to be done!
IFEANYI NSOFOR
Ifeanyi is a member of the Nigeria Health watch.
Medical tourism company in India
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