Wednesday, 24 August 2011

An air ambulance to India

A friend of mine travelled from Lagos to New Delhi for a business meeting, and called me shortly after his return. "Chikwe, you will not believe what I experienced on the flight; almost every passenger had a tube of some sort, from catheters to intravenous lines, often accompanied by nurses or/and family, both in business class and economy class, all headed to India for healthcare that they cannot get in Nigeria". He said it felt like being on an air ambulance. A Nigerian newspaper speculated that at  least 3,000 Nigerians travel each month for medical treatment to India, spending close to $200 million (N30 billion) yearly. While it is not clear where these figures come from, another newspaper is explicit in reporting that the Indian High Commission in Nigeria issued 4,000 medical visas to Nigerians seeking medical treatment in Indian hospitals in 2009. This is what has become of our once great country.

What started as a niche endeavour, often for serious conditions such as renal transplants has evolved into big business. As the years have progressed, more and more people are losing confidence in the services offered by our hospitals in Nigeria, and raise funds desperately to go to India for even minor ailments. Indian hospital services have risen to the challenge of the discerning Nigerian, who often come with his payment in cash and have access to a wide range of care, but also ancillary services including airport pickup, accommodation for the family, support with logistics in India and even phone cards to call home. All of this can easily be organised over the internet by companies specialising in "medical tourism". But it does not end there, at the end of treatment, patient "testimonials" are put up on hospital websites as this one. There are even emerging "innovative" health insurance packages offering healthcare in India.

Not satisfied with the Nigerian patients coming to India, they are bringing Indian healthcare to Nigeria. The famous Apollo Hospital group recently announced plans to build a hospital in Nigeria. A modestly named Primus International Super Specialty Hospital has recently started providing health care services from Karu, in Abuja, and it appears that Nigerians have not wasted any time in making it their new favoured destination for health care in Abuja.


So why has the Nigerian healthcare industry not evolved and kept pace with the rest of the world. Like India, we have Nigerian doctors trained and are working in the best healthcare sectors in the world. Across the USA and the UK, Nigerian doctors have reached the very peak of their professions. We have a growing and discerning middle class. We had pioneers in the provision of private health care in groups like Eko Hospitals. We have huge banks with money to spare to finance projects in healthcare. Mckinsey in its important report in 2009 stated that:

The expected improvement in Africa’s macroeconomic climate over the next decade will expand the healthcare gap, as higher incomes will create new demand for quality.
So, while we are happy for the entrance of India into the Nigerian health scene, at least for the sake of those that are not able to travel, we really need to see some of the innovation that has driven the growth of the telecommunications industry, the financial services industry brought to bear in the health sector. The truth is that such innovation will not necessarily come from doctors, infact it is unlikely to!  For growth to happen, we need innovation in financing models, management models as well as the core medical expertise. No country's health sector has grown with a fee-for-service structure as is presently pervasive in Nigeria.

I truly believe that the health sector is the next big thing.....but it will depend not on the money we throw at it, but on our ability to combine our intellectual capital to find a workable solution for Nigerians. Because of the pace of development around the world, this will have to come both from expertise in Nigeria and in the Diaspora.

Nigerians can do this....! If not for our health, for the money. While investing in the Indian economy is great, investing in the Nigerian economy is even greater, and maybe we can save a few lives in the process.

In my life time, I hope we will see people travelling to Nigeria for their health care - as one of my mentors says - we have to set BIG BOLD and AUDACIOUS goals for ourselves - this is one! 


Lets go do....




3 comments:

Anonymous said...

Dear Chikwe,
well noticed ( Nigerians flocking to India to pay huge sums for care) and well blogged. Thank you.

There are many reasons why Nigerians have not matched the Indians in medical tourism: small solo clincs in boys' quarters ( against the law of economy of scale), cannot get anybody anywhere apart from its contribution to our high morbidity and mortality. etc.

But perhaps the most hideous reason is the strictures imposed by a harsh financial services on the health sector. Hear this:
We tried raising some finance, supported by an specialist-crafted, excellent business plan, for a hospital that we are setting up. All the financial houses said to us that we must pay back in full within one year!, Yes you nheard me right, within one year!. We asked for a breathing space of six months before repayment starts. And they all said, fine, but that means you pay back in 6-motnths. Yes 6-moths.
But I remember taking a similar health facilty finance in the UK in 1994 and offerred to pay back in two years, and tghe Bank manager said to us, no!, you cannot pay back in two years, take 3-years, beacuse from their experience it is more feasible, if the business is not to crash even before it starts, and they lose their loan as well. . Such business sense still eludes us in Nigeria.

Best wishes,

Joseph Ana

imnakoya said...

With the way Nigeria is operated -- the lopsided federal structure that has created strictures and inefficiencies that in every facet it’s involved, it will be difficult to attain bold and audacious goals.

Until the government is willing to step aside, create incentives, and regulate the private sector, in the delivery of healthcare (and other services), Nigeria will remain ineffectual and without progress.

In my opinion, let the govt focus on creating and regulating a conducive environment, but let the private sector build, operate and manage. For instance, the feds has no business building and managing trauma centers in each geopolitical zone (as planned) when there are capable investors and managers in the private sector that can do the job.

Achieving those bold and audacious goals require private sector competence and trust that only an enabling environment created by the public sector can deliver.

Anonymous said...

Our healthcare delivery system until few years ago has not been subjected to scrutiny as it is being done now by young people who have benefitted from the best education across the globe. The idea of using outcome based model to assess our healthcare system would help standardize care, encourage inveatment and increase influx of well trained Nigerians back to the system. To beat the India trap, we must invest on our young heads, trust them with responsibilities, promote reintegration based on expertise and allow them chart a new course for healthcare delivery system based on concept of evidence based medicine and not eminence based medicine