The impetuous decision of the President, Major-General Muhammadu Buhari (retd), to abandon his duty post in the middle of a pandemic to consult medical doctors abroad exposes the legendary hypocrisy in his leadership style, which remains unparalleled in the political history of Nigeria. That the President decided to leave on the eve of the start of a nationwide strike by resident doctors reveals a leader who has no regard for Nigerians.
According to a tally by The PUNCH, Buhari has spent over 200 non-consecutive days on medical tourism in the United Kingdom since he took office in May 2015. His longest visit was in 2017 when he spent 51 days from January 19 to March 10; and 104 days from May 8, 2017 to August 19, 2017, all paid for with public funds. Although the Presidency has rejected Freedom of Information requests on the sums spent on Buhari’s needless travels, an analogous report of the BBC on its website in 2018 said it cost £360,000 for parking fees of the Presidential aircraft that ferried Buhari there that year. This gives a glimpse of how Nigeria’s funds are being wasted by a man who rode to power on the promise to instil fiscal prudence and accountability, claiming in 2014 that he obtained a bank loan to buy the Presidential form of his political party.
Buhari’s gratuitous visit to the UK is indeed self-implicating. A recent poll shows that 88 per cent of Nigerian doctors are considering work opportunities abroad due to the nation’s decaying health sector. The General Medical Council, the government body that maintains the UK’s official register of medical practitioners, listed over 8,000 Nigerian-trained doctors in the UK, adding that Nigeria has the third highest number of foreign doctors in the country. Selflessly, the UK Government introduced a policy in February to discourage the recruitment of doctors from Nigeria and other countries facing a shortage of doctors at home. In the middle of all this, the President of Nigeria travels to the UK for medical tourism. This is indeed shameful.
The body language of a leader speaks volumes. Just two weeks ago, the President took the COVID-19 jab on live television to prove to citizens that the vaccines are safe and to boost their confidence in the domestic health sector. But after this endorsement, the President jets out for treatment abroad. Such mixed signals expose the cluelessness of a man who once vowed to curb the medical tourism that drains over $1 billion a year, which rivals the Federal Government’s current health budget.
The inappropriate actions of a leader give others the impetus to do the same. Just last year, the Chief Justice of Nigeria, Tanko Muhammad, was in Dubai for medical treatment, ditto for the President’s wife, Aisha, who has become an inveterate tourist. Erstwhile acting Chairman of the Economic and Financial Crimes Commission, Ibrahim Magu, last January visited Dubai to treat appendicitis. Who pays for these expensive medical trips? With the political class’ penchant for medical tourism, it is no surprise that a bill to regulate overseas medical treatment for public officials was thrown out by the House of Representatives in 2019.
Indeed, the COVID-19 pandemic was a mixed blessing as it prevented Buhari from visiting his UK doctors as frequently as he had done in previous years. The President was forced to make only three international trips that year, thereby saving the country a substantial part of the N1.75 billion earmarked for his foreign travels in 2020. But instead of sustaining the tempo of cutting the astronomical cost of governance, Buhari has returned to his old ways. Unsurprisingly, under his watch, the budget for the Presidential fleet has increased by 191 per cent in just four years with N12.5 billion earmarked for the aircraft in the 2021 budget.
For too long, Nigeria has spent too much money on frivolities and has failed to make critical investments in the health sector, citing paucity of funds. But there are other developing nations that have been able to turn around their health systems even in the midst of scarcity. President of Rwanda, Paul Kagame, received commendation at the World Health Assembly in 2018 for attaining Universal Health Coverage of 90 per cent in a country which 24 years earlier collapsed due to a civil war. In contrast, Nigeria’s health coverage stands at a paltry 5.0 per cent.
Cuba, with a GDP less than quarter of Nigeria’s, has consistently expended more than 10 per cent of its GDP on health expenditure. These investments in the health sector helped Cuba become the world leader in the ratio of doctors to population with 67 doctors per 10,000 persons or one doctor per every 149 citizens, far above the WHO’s recommendation of 1:600. Having met local demand, Cuba now leases healthcare professionals to foreign governments, a policy that brings in around $11 billion each year, making it a bigger source of revenue than its tourism industry, according to TIME magazine. There are currently some 50,000 Cuban doctors working across 67 countries like soldiers on a foreign peacekeeping mission, an “army of white coats,” as Cuban officials call them.
But in Nigeria, the opposite is the case. The doctor/patient ratio is 1:3,500. The country has consistently failed to invest in its health sector because there is no incentive to do so since public officials have the option of patronising foreign hospitals, often times at taxpayers’ expense. The result has been the neglect and the poor capacity of the public health sector to effectively tackle preventable diseases like Lassa fever, cholera, meningitis and yellow fever. The WHO says the health indicators for Nigeria are among the worst in the world. Nigeria shoulders 10 per cent of the global disease burden. It has the highest rate of malaria infections and the third highest HIV burden on earth. The country has very high infant and maternal mortality rates such that the risk of a woman dying in pregnancy or childbirth is one in 15, compared to one in 5,000 in developed nations.
Nigeria’s health sector is considered to be one of the worst globally. A 2018 study in the Lancet of global health care access and quality ranked Nigeria 142nd out of 195 countries. Buhari can learn from Rwanda’s experience as the Bill Gates Foundation reports: In 1994, its entire health system was in ruins. The country was in the midst of a brutal genocide that claimed the lives of as many as one million people, including many of the country’s doctors and health workers. Many others fled.
Then came more tragedy: The world’s highest child mortality rate and its shortest life expectancy. Agnes Binagwaho, a doctor, spearheaded the rebuilding of Rwanda’s health system after the genocide. One of her first orders of business was to train thousands of community health workers who went from home to home to care for the poorest families. Chosen for the post by their own villages, the workers have built-in trust and accountability. And together, they began the work of rebuilding Rwanda’s health system.
Today, this system is a model for other countries. Infant vaccination rates top 97 per cent —four times what they were in 1994. Everything from child and maternal mortality rates to AIDS, malaria, and tuberculosis deaths have dropped significantly.
Unfortunately, Buhari does not seem to realise the monumental task before him since he mostly patronises the British health care system. The President must note that there is nothing honourable about a leader who seeks medical help abroad, but abandons his people to bear the brunt of a decaying health sector worsened by his incompetence. With about two years left for him to complete his tenure, the question remains; what sort of legacy does Buhari hope to leave behind? The President must resolve to prioritise health reforms and set an example by patronising only local hospitals. Once he leads by example, other public officers will be encouraged to fall in line. This will in turn provide the incentive for health sector investments.
