The Central Bank of Nigeria, CBN, has released guidelines for operations of N100 billion credit support for the healthcare sector following the outbreak of COVID-19 in the country. In a circular signed by Kevin Amugo, Director Financial Policy Regulation Department, the apex bank indicated that indigenous pharmaceutical companies and healthcare practitioners that wanted to expand or build their capacities would benefit from the scheme.
Recall that the CBN had earlier announced the N100 billion intervention for the healthcare industry to strengthen the sector’s capacity to meet potential increase in demand for healthcare and services. In the guideline, the apex bank noted that the scheme would provide credit to indigenous pharmaceutical companies and other healthcare value chain players intending to build or expand their businesses. The CBN said the scheme was also expected to increase private and public investment in the healthcare sector, facilitates improvement in healthcare delivery and reduce medical tourism to enhance foreign exchange conservation.
The bank further explained that the objective of the scheme was to provide long-term low cost finance for healthcare development that would lead to the evolvement of world-class healthcare facilities in the country. According to the bank, the scheme will improve access to affordable credit by indigenous pharmaceutical companies to expand their operations and comply with the World Health Organisation’s good manufacturing practices. The CBN noted that the eligible participants under the scheme were healthcare products manufacturers and pharmaceutical equipment.
It added that others are healthcare service providers, medical facilities, pharmaceutical and medical products distribution and logistics services among others. The CBN said the Deposit Money Banks and Development Finance Institutions were eligible to disburse the fund.
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Recalled that, The Minister of State for Health, Dr Osagie Ehanire, has revealed that Nigeria loses over $1 billion, an equivalent of N400 billion, annually to medical tourism. Ehanire made the disclosure during the opening ceremony of Grays Cardiology Centre, the first comprehensive cardiology centre in Lagos Mainland established by Reddington Healthcare Group in GRA Ikeja. The minister, who lamented the continued lack of faith in the national health system and the attendant financial implication of seeking healthcare services in other lands, said that “medical tourism is one of the major contributors to foreign exchange depletion, to the tune of $1 billion annually”. Disclosing that challenges such as “inequitable distribution of facilities, limitation of material, financial and human resources for health, poor attitude to work in the public health care sector, strike actions and inter-professional discord” were responsible for the lack of confidence in the national health system, the minister said that the federal ministry of health was working assiduously to regain confidence in the health sector.
Speaking he said, “The Federal Ministry of Health (FMoH) is furthering the revitalization of nearly 10,000 primary health care centres (PHCs) in Nigeria, at least 1 in every political ward, working with states and our development partners, to rebuild the National Health System from the foundation, including plans for a referral system to relay patients through secondary to tertiary facilities”. Ehanire who lauded the initiative of a state-of-the-art cardiac centre said that the Buhari-led administration was committed to rebuilding the health system through private sector engagement. “Government desires to encourage more private sector participants in health care delivery. The injection of private capital, management skills, innovation and discipline should lead to the modernization of health care delivery in Nigeria and overall improvement of the health system. “The FMoH, through the department of public-private partnership (PPP) and diaspora, is keen to collaborate and partner with private health care providers and Nigerian health care experts in the diaspora in what Mr President calls “knowledge and skills repatriation”.
The Chief Executive Officer of Reddington Healthcare Group, Dr Yemi Onabowale said that the centre will be “dedicated to the practice and teaching of cardiovascular medicine”. “The Grays Cardiology Centre will offer services covering non-invasive and interventional procedures, heart diagnostic procedures, cardiac rehabilitation, intensive coronary care, telementry services, heart care education, amongst others.” The Medical Director of the new centre, Dr Soe Moe Aung, gave his assurance that the latest medical technology in cardiology will be used to provide the expertise to ensure that all patients receive world-class medical care.
Medical tourism is a phrase that is commonly used to describe the phenomenon of foreign patients seeking healthcare in another country at better equipped hospitals and at medical fees comparatively cheaper than in their home countries. In other words, medical tourism refers to “visit by overseas patients for medical treatment and relaxation”. The term medical tourism is an amalgamation of two distinct services – healthcare and tourism. The reality, however, is that it is difficult to associate the word tourism with chemotherapy, heart surgery, kidney transplant and other related treatment of chronic diseases. The World Tourism Organization defines tourists as people who “travel to and stay in places outside their usual environment for more than twenty-four (24) hours and not more than one consecutive year for leisure, business and other purposes not related to the exercise of an activity remunerated from within the place visited. From the above, it can be deduced that tourism involves particular activities selected by choice and undertaken outside the home. Accordingly, medical tourism has emerged as a form of travel activity undertaken for medical purposes and rest.
Compared to other forms of tourisms, namely leisure tourism, winter tourism, summer tourism and mass tourism; medical tourism, which is a form of adjectival tourism, is a recent phenomenon. Adjectival tourism refers to the numerous specialty travel forms of tourism that have emerged over the years, each with its own adjective. Many of these terms have come into common use by the tourism industry and academics. Apart from medical tourism, other examples of the more common emerging adjectival tourism markets include Agri-tourism, Culinary tourism, Cultural tourism, Ecotourism, Geo-tourism, Extreme tourism, Heritage tourism, Medical tourism, Nautical tourism, Pop-culture tourism, Religious tourism, Slum tourism, War tourism, Sex tourism, and Wildlife tourism. Apart from these, other emerging forms of tourisms include sustainable tourism and space tourism, amongst others. It is beyond the scope of this paper to delve into these mentioned aspects of tourism in detail. That notwithstanding, it is pertinent to note that the medical tourism sector continues to grow at an increasingly fast rate and has emerged as a major force for the growth of services exports, not only in India, but worldwide. Apart from India, countries like the United Kingdom, Middle East, Japan, U.S., Canada, Belgium, Costa Rica, Cuba, Dubai, Hungary, Israel, Jordan, Malaysia, Singapore, South Africa, Thailand and several others have emerged as active players in the medical tourism business.
India has emerged as major player in global medical tourism and has become the destination of choice for afflicted Nigerians who can afford to, or are compelled by fate of ill-health, to seek medical attention in that country. According to the Indian High Commission in Nigeria, 47 percent of Nigerians that visited India in the year 2012 did so to seek medical attention, while the remaining 53 percent did so for business, training, tourism and as students. The 47 percent of Nigerians that visited India for medical purposes amounted to 18,000 persons out of a total of 38,000 visas issued to Nigerians visiting India in 2012. The Nigerian medical tourists to India expended N41.6 billion (US$260 million) in foreign exchange in the process. The trend resulted from the inequality in access to healthcare and dearth of specialized medical facilities, which have remained a critical challenge to Nigeria’s healthcare provision.
Despite prevalent political and economic challenges, medical practice in Nigeria has experienced remarkable progress in recent years. Modern day management centers are increasingly abundant, with the capacity to carry out advanced medical procedures and refinement of common procedures (advanced fertility treatments, minimal access surgeries, transplant procedures, joint replacement surgeries and availability of improved diagnostic techniques, etc). Many of these advances in the management of patients are due to significant investments in infrastructure and training. Knowledge of the advances being made especially in private health facilities are limited to those working within their immediate environment. Many physicians practicing in different parts of the country do not know of the advances in health service delivery now available in the country, less so, the ill patient who may require these services as an emergency or lifesaving intervention. The poor level of awareness and knowledge of available services by physicians and the general population can be attributed to a long standing medical code which bars orthodox health practitioners from advertising their services.
In addition, there is a scarcity of scientific conferences and interdisciplinary seminars to foster the dissemination of useful clinical and research knowledge among stakeholders. The Code of Medical Ethics in Nigeria: Rules of Professional Conduct for Medical and Dental Practitioners in Part F (Self advertisement and related offences: relationship with the media) particularly frowns at public advertisements by physicians and health facilities and only permits the distribution of patient information leaflets on services offered to patients and their relatives within the premises of the health facilities. Similar codes were in effect in several developed countries prior to their repeal. To further worsen the precarious situation is the growing incursion of unorthodox physicians within the country – who are not bound by similar laws – and the rise in international medical tourism coupled with the aggressiveness being undertaken by these foreign institutions and their marketers to attract clients from other countries. Thus, it has become imperative to voice concerns on the danger that the persistence of this medical code poses to the Nigerian public as well as the medical, ethical and socio-economic impact on both patients and hospital owners.
Medical tourism, which is the travel to another country for the purpose of treatment, is growing. The increasing recruitment of patients from Nigeria provide a call to action for hospital owners, the Association of General and Private Medical Practitioners in Nigeria (AGPMPN), the Nigeria Medical Association (NMA) the Federal Ministry of Health and other stakeholders to begin advocacy for the repeal of the code of medical ethics against advertisement by physicians and health practices by the Medical and Dental Council of Nigeria (MDCN). As a result of the growth, a new terminology and accompanying industry “Medical Travel Facilitators” or “Medical Tourism Facilitators” (MTF) has emerged comprising of individuals and companies that connect patients to medical providers across countries. The growth in this industry has been fostered by rising cost in healthcare and lengthy wait times in developed countries, limited number of specialist practitioners, poor information on services within countries, and distrust in the quality of care by local healthcare providers in developing countries. Medical travel from the developing world used to be mainly by the affluent in these countries.
However, the increasing availability of world class health facilities in low and middle income countries (LMIC) and the expanding middle class in several developing countries who can pay for these services, has increased the population traveling to other countries for care. India is one of these destination countries. They have facilitated potential economic gains in this industry with the creation of a class of visa for medical tourism, and with projected economic growth to reach US$ 69 Billion (8.5% of the GDP) in the next few years [9]. Some of the destination countries governments’ have favorably supported the growth of this economically viable sector. Such government’s support of private healthcare businesses is obviously lacking in departure countries like Nigeria, and the tide must be turned around to ensure these governments can offer their citizens the best within their country which is the essence of governance.
The increased access to internet services via mobile telecommunication service providers in Nigeria, in addition to the rapidly growing subscriber base of social media communities like Facebook, Twitter, LinkedIn and Instagram have created viable marketing channels for cross border advertisement. This has facilitated the recruitment of patients at the detriment of health facilities in the country which continue to experience underutilization of their facilities. The modalities these external institutions use to reach out to patients are quite innovative and continue to cause significant imbalance for health facilities within the country that do not have the opportunity to advertise the kind of services they render. Additionally, the ethical implications that these cross border health marketing results in are diverse which are often significant undertones hardly considered by the medical tourists.
Hence, there is the exigent need to drastically improve medical facilities across board in the country, with the attendant required medical personnel. Nigeria can ill-afford to be losing 400 billion to medical tourism on an annual basis. It is for this reason that the intervention fund at this time is highly commendable.
***Â Written by Jide Ayobolu.
