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Health tourism by Africa's leaders costs their countries dearly

Many of Africa's leaders have neglected the health care needs of their people, while selfishly finding treatment for themselves and their families abroad, writes Olusegun Akinfenwa in Immigration News.

Akinfenwa writes:

The right to health is a fundamental human right enshrined in international law. This creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality, according to the World Health Organization (WHO) constitution. The right to health must also be enjoyed by all without prejudice on ethnicity, race, age, or status.

While most African countries are signatories to this constitution, the reality is totally difference from these tenets.

Whereas the constitution emphasises governments' obligation to allocate maximum available resources to health and prioritise the needs of those furthest behind first, many African leaders treat public health as an unimportant issue, with little or no regards for their citizens. They selfishly cater only to their personal and family medical needs.

The patronage of foreign health care is a common pattern among African leaders. It has left the medical sector in many countries in a deplorable state with devastating human and financial effects.

While seeking election in 2015, President Muhammadu Buhari of Nigeria promised to end medical tourism by public officials. But just like many of his campaign pledges, the former military ruler has broken this promise several times and spent more than 180 days in the UK on medical tourism, including his recent London trip in April. On one of his infamous trips to London in 2017, the 78-year old leader spent four months away.

At just about the same time, President Patrice Talon of Benin Republic also went to France for surgery. Ali Bongo of Gabon, Abdelaziz Bouteflika of Algeria and Jose Eduardo Dos Santos of Angola are some other current and former African presidents fond of this act.

In 2019, former Zimbabwean president Robert Mugabe made the list of African leaders who died seeking medical attention overseas when he passed on at a Singaporean hospital. The list include Nigeria’s Musa Yar’Adua who died in Saudi Arabia in 2010, Guinea Bissau’s Malam Bacai Sanhá in France in 2012, Ethiopia’s Meles Zenawi in Belgium in 2012, and Zambia’s Michael Sata in the UK in October 2014.

Apart from South Africa, Egypt and a very few others, health indications in most African countries are very poor, owing to the huge gap in healthcare funding. The situation is worse in the sub-Saharan region, which has the highest disease burden on the continent and globally.

Failure to improve the medical sectors in their countries is the chief reason why African leaders fly abroad even for their most basic healthcare needs.

The effects are telling not only on the masses but also on the experts who are sometimes forced to treat patients with sub-par medical equipment and experience daily poor working environments and pay. Due to this, many skilled physicians have left their home countries for greener pasture and career fulfilment, mostly in the US, Europe, Canada and other locations.

This has thrown the continent into a dire shortage of doctors. For instance, the doctor to patient ratio in Nigeria is 3.8 per 10,000 persons – far below the WHO recommended 1 to 1,000 persons. Likewise, Benin, Guinea, Burkina Faso and Togo only have 0.8 doctors per 10,000 people. It's worse in Sierra Leone and Liberia, with 0.3 and 0.4 doctors per 1,000 persons, respectively.

Despite the shortage, however, the few remaining ones continue to migrate in droves to countries where their service is appreciated. For instance, 1 in 10 doctors working in the UK are said to be from Africa, according to a report by The Lancet. A good number of them are on indefinite leave to remain status in the country – an indication that they will most likely end their career in a foreign country.

Just like many other humanitarian issues on the continent, children and women bear some of the greatest burdens of the deplorable health system. For example, maternal and child mortality in most African countries is also on the rise, as the continent accounts for two-thirds of global maternal deaths. A mother in sub-Saharan Africa is more than 100 times likely to die during childbirth compared to women in Western Europe.

Data from shows that the top 20 countries with the highest maternal mortality rate per 100,000 live births are all African countries. Furthermore, out of about 5.2 million children under age five who died in 2019, more than half happened in sub-Saharan African nations.

A study by the World Economic Forum revealed some of the factors influencing this include poor antenatal care, lack of skilled birth attendants, and delivery in poor facilities. Negligence on the part of African leaders leaves the health care system in most countries poorly regulated. Many African women give birth at home, traditional birth centres, and faith-based institutions, which increase the risks of childbirth complications.

The overall quality of life vis-à-vis average life span is below par. Globally, Africa sits at the bottom on the life expectancy ranking. The average life expectancy of males is 62 years while that of females is 65 years. This is lower than the global average, which is at 70 years and 75 years for males and females, respectively.

More specifically, the 10 countries with the lowest life expectancy are all African countries. This includes Mali, Cameroon, Equatorial Guinea, Guinea-Bissau, South Sudan, Cote D’Ivoire, Nigeria, Sierra Leone, Chad, Lesotho, and the Central African Republic. The defective health care system makes many Africans spend a good part of their life in poor health, thereby making average healthy life expectancy even much worse.

In addition, the gap in healthcare funding in most African countries is on a steady rise, particularly in sub-Saharan Africa. As of 2015, African countries accounted for just 1% of the total global health expenditures. This is poor for a continent with a 66% burden of disease due to non-communicable diseases (NCDs) and injuries, measured by the proportion of total disability-adjusted life-years (DALYs).

Comparatively, other continents spend about 10 times more than Africa on health care. Fixing this gap could take years, but most importantly, it will cost the continent billions of dollars. Unfortunately, with their body language, many African leaders appear unbothered about the situation, and this may further worsen the already devastating challenge.

Affordable and accessible health insurance scheme is alien to many African countries, resulting in high out-of-pocket medical expenses, despite the poor economic realities. This puts a lot of Africans seeking healthcare at financial risks. For example, in Kenya, about 1 million people are pushed into poverty due to out-of-pocket payments.

Africa also has some of the highest death rates from preventable diseases, including malaria and diaorrhea. 94% of malaria cases and deaths in 2019 were recorded in Africa, and about half of the total cases occurred in just six African countries. They include Nigeria, the Democratic Republic of the Congo, Tanzania, Niger, Mozambique, and Burkina Faso. Nigeria recorded the highest at 24%, mostly due to its high population.

According to the WHO, measles cases in Africa increased by 1,606% from 2016 to 2019. Also, in 2020, there was a significant increase in measles cases in Africa, putting the continent at risk of an outbreak. Although diarrhoea diseases are both treatable and preventable, many children under 5 in sub-Saharan Africa die from it annually.

Dishearteningly, the economy also suffers greatly from African leaders’ insatiable appetite for foreign medical service. As far back in 2012, the Ugandan government was reportedly spending about US$150 million every year to treat top officials overseas. The same amount could build about 10 world-class hospitals and significantly improve the country’s health care system.

In 2017, there were reports of the Nigerian government paying up to $4,000 per day to park the presidential jet while the president visited the UK for treatment.

All these devastating effects are a culmination of the lingering negligence of one of the most crucial sectors in national and continental human and economic development. It is high time African leaders led by example and created affordable, accessible and quality healthcare for the masses, instead of flying abroad for their personal medical needs.

The huge cost spent on medical tourism should be channeled towards improving the poor system in the continent. This will go a long way in reducing child and maternal mortality, shortage of experts, and improving the continent's overall quality of life.


Olusegun Akinfenwa is a correspondent for Immigration News, a news organization affiliated with Immigration Advice Service London, an immigration law firm that helps people migrate to and settle in the UK.


See also from the MedicalBrief archives:


Most of Africa’s leaders seek their medical treatment abroad


Motsoaledi slams ‘health tourism’ by African leaders


Medical 'voluntourism' in Tanzania: Some help does cause harm

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