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HEALTH INTERACTIVE WITH DR. AMINU MAGASHI Cost Analysis; Seeking Health Care Abroad The Guardian Newspaper Editorial of Friday , May 11th , 2007 titled “The alternative of seeking treatment Abroad” reported the out going Minister of Health , Professor Eyitayo Lambo to have said that “the alternative of seeking medical treatment abroad is the right of every Nigerian provided he/she can afford the cost. He further stressed that this does not necessarily mean that the treatment cannot be procured in Nigeria, implying that it may even be cheaper in Nigeria. This, he maintained, is part of the freedom of the individual, the inalienable right to choose.” Anybody following the debate about the health crises in Nigeria would know that the issue is never of “Private Individuals” seeking for health care abroad. It is the right of those who can afford and no one has any problem with that. The minister has not only goofed but it shows how insensitive our leaders could be to the plight of many Nigerians who cannot afford even the basic health care locally. The debate is about the Collapsed Health Sector in Nigeria vis-à-vis our leaders with the slightest physiological change in their body system leaving the shores of Nigeria to seek for health care abroad . That became apparent when within short interval during the election period, two presidential candidates; Alhaji Atiku Abubakar and Alhaji Umaru Yar’adua all flown to London and Germany over alleged minor ailments of Catarrh and Knee Ligament Tear respectively . The minister as the Number One Chief Health Officer in Nigeria and his bosses over the last Four years have failed to provide quality health services across the country . They should bury their faces in shame , just like the way Mallam Habu Dauda Fika , the AmanaOnline Webmaster put it in his article “Overseas Medical Care ; Our Shame” posted at Nigeria Village Square Website (http://www.nigeriavillagesquare.com/index.php/content/view/5292/55 ) . He mentioned among others that “It is the consequence of our bankrupt leadership and the endemic corruption that has now encumbered us with a two-tier healthcare system, one for our leaders and one for the rest of ordinary Nigerians. Our so called leaders receive the best care that money can buy, in overseas hospitals, while ordinary Nigerians who cannot go overseas are condemned to seek care in our less-than glorified clinics. Conceivably, due to this cruel practice, Nigerian leaders have refused to modernize the inadequate healthcare system.” Since 2004 , the Minister and his cohort are peddling Health Sector Reform Document that proved difficult to implement or become a Health Care Act through the process of legislation . When I met some of his directors in Arusha , Tanzania in April 2005 at a 2 Week Health Sector Reform Programme , it was the same issue they sang to us about reform . The reform at the Tertiary Health Institutions to make it efficient and effective is yet to take place apart from threats of strikes from Medical Doctors and other health personnel. Our country is the second highest contributor to Global Maternal Deaths, so also Child Mortality , HIV/AIDS are worse . If one take any health indicator , over the last four years , it has move from bad to worst . National Health Insurance Scheme which is an effective mechanism to ensure everybody is covered to have access to health care , this administration spent its entire life span of Eight Years planning and designing the process. It is only now, that civil servants are been registered in the scheme. That aside , it will be good to look at “Cost Analysis” as its relates to seeking health care abroad . This attempt is not an Economic Evaluation that will come out with figures and specific cost as I am constrain to engage in that process due to studies commitment , limited resources and time , however , the exercise will identify the inputs and also serve as opener as to what it entails if our leaders flee Nigeria for health care abroad . It will also help us to start planning for detail economic evaluation and advocacy . Cost analysis is important because resources are scarce and when ever money is used for a particular event, it means it is not available elsewhere. If Nigeria’s President, VP or an Executive Governor goes to London as an example for a medical check up , there are so many inputs that need to be analysed . First and Foremost is the Direct Cost (It covers the direct cost of care such as payment for medical consultation , laboratory procedures , drugs and the duration he/she stays in the hospital . The Indirect Cost ( It covers his/her daily travelling allowances , cost of International Travelling and hotel accommodation before and after moving in to the hospital ) . Another Indirect cost been incurred is the expenses for all those political aides and family members that escort the politician ( Visa Fees , Daily allowances , cost of travelling and hotel lodging ) . In Cost analysis, Intangible cost is also considered (cost of inconvenience and discomfort during journey) . “Opportunity Cost” is another important dimension to measure (cost of foregone alternatives that will bring benefit to Nigeria as a result of the journey ) . This can be evaluated from the angle of how much a state or the country will lose because of the politicians and their aides’ absence in working place . If we have an economic assumption that a Nigerian President and 36 State Governors go for medical check up every quarter of the year (4 times ) and 774 Local Government Chairmen go twice a year and we also add Ministers , State Commissioners , Head of Parastatals and their families , plus the indirect cost of those who escort them , one can begin to imagine how much Nigeria is losing yearly on financing health care abroad . We are losing money runs in Billions of Dollars, while our health care at come cannot cater for catarrh and Knee Joint Injury. The money we are losing yearly, if put to use, will revamp our Collapsed Health Sector and provide the best services money can buy . Economic Evaluation will compare seeking health care in Nigeria and Abroad in terms of Cost-Effectiveness, Cost-Benefit and Cost –Utility Analysis and our hypothesis is that, it is more effective for us to fix our health sector that will provide for our leaders as well as the common man than to be losing all these huge resources in financing shopping in the name of health care . It is imperative for our outgoing Minister of Health to know that it is not a right for our politicians to take our money and waste it in the so called seeking health care abroad. It may be a privileged of the office which of course need to come with responsibility and commitment to the Nigerian populace . It is my sincere prayer that the next Minister of Health comes May 29th and the 36 State Commissioners of Health will see the need to reform our health sector as a “Do or Die Affair”. This is one of the few instances where I believe the phrase introduced by Nigeria’s out -Going President Olusegun Obasanjo in to our political lexicon is relevant. In the health sector , if one refuse to act ( do ) , a lot die and perish from preventable illnesses . Dr Magashi is a Masters Student (Public Health) at London School of Hygiene and Tropical Medicine. . He can be reached at gamagashi@gmail.com
Future Article: My next article will be “Health Care Financing; Options for Nigeria”. In that , I will be making references to some countries’ health financing mechanism , to draw lessons learned for replication .
Re: The need to reform Nigeria’s Health Sector
It is my sincere pleasure to thank the following people for sending me valuable contributions and comments on my last article. Thank you very much and may we continue to network towards improving Nigeria’s Health Sector . They are : Mr Joseph McCarthy ( Newcastle , UK) , Eshiemokhai Michael (Linkoping , Sweden ) , Bashir Muhammad ( Kano , Nigeria ) Dr Magnus A. Azuine ( Washington , USA ) , Dr Kabir Mustapha ( Abuja , Nigeria ) , Dr Fatima Aliu (Philadelphia, USA ) , Mustapha Ali Busugumu ( Maiduguri , Nigeria ) , Dr Abdul Sani ( Havana,Cuba ) , Uwais Idris Abubakar ( Nottingham , UK ) , Casmir Igbokwe ( Cardiff , UK ) , Agbons Iserhienrhien ( Abuja , Nigeria ) Dr. Ibrahim Y. Oloriegbe ( Abuja , Nigeria ) , Dr Usman Bashir ( Kano , Nigeria ) , Bunmi Abby ( London , UK ) , Dr Temitope Awofeso ( Bristol , UK ) , Abdulhamid Bagara ( Kano , Nigeria ) , Dr Rabiatu Hadi ( Sheffield , UK ) , Dr Taiwo O Fasoranti ( Houston , USA ) Ibrahim Muhammad Sani Gumi ( India ) , Dr Ike Anya ( London , UK )
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