Breaking point thoughts

Why do prominent Nigerians seek medical care abroad?

Preparing for his seventh year in office, General Muhammadu Buhari provided an answer to this question last week: Nigerian medical care workers (minus the doctors) are unfriendly.

For perspective, it must be remembered that the General himself is Nigeria’s poster boy for international medical tourism. It is on record that in his first three years in office, he spent over 170 days in London enjoying that city’s medical system, even ignoring a crippling strike at home of nearly 100,000 medical personnel.

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When he was campaigning, however, he he had condemned the practice, and after he took office, declared that he would “certainly not encourage expending Nigerian hard-earned resources on any government official seeking medical care abroad, when such can be handled in Nigeria.”

It is strange that after all these years, his explanation for reneging on his promise is simply that Nigerian medical care workers are hostile.

“Such simple failings like this, are more frequently responsible for the loss of confidence of the end users in our health system than even the lack of equipment,” he diagnosed last week.

And his prescription? “I want to believe that the managers of our hospitals after such laudable, fantastic infrastructure investment we now begin to pay attention, not only to improving staff harmony and welfare, but to retraining health care givers for even better professionalism that deliver service in a productive and courteous atmosphere based on the lessons we learnt from our traditional African hospitality”.

Only one part of this argument is meaningful: the attitude of the public service worker, and I agree with General Buhari that the time has come to work to make him better.

But that applies not only to the medical sector, but in all of government work. And it cannot begin when a Nigerian leader sees nothing wrong with abandoning a paralyzing labour strike simply because he can take care of himself abroad, at public expense and with no accountability.

This is of greater concern when one remembers that in his expensive patronage of London hospitals, Buhari abandoned the Aso Rock Clinic aka State House Medical Centre (SHMC).

In 2017, even the First Lady was shocked to discover that the clinic did not even have an x-ray machine for her use.

Their daughter, Zahra Buhari, sniggered on Instagram: “More than N3billion budgeted for the State House clinic and workers there don’t have the equipment to work with? Why? Where is the money going to? Medication only stocked once since the beginning of the year? Why?”

One observes that Buhari’s family did not blame “unfriendly” workers, as he now does. Their questions were about a system that had collapsed. Aisha Buhari got her x-ray questions answered in an Abuja hospital owned by foreigners, she said. Buhari himself gets on the executive jet heading abroad.

In other words, the questions crying for answers are not about medical workers, they are systemic, but those who should be answering them only diagnose but do not treat.

Part of this systemic crisis is the corruption of which the Buhari government has become the champion because it promotes nepotism and mediocrity over merit.

When people other than the most qualified assume positions, there is no motivation to give their best.

Remember: in March 2016 for instance, the scandal broke of the Central Bank of Nigeria undertaking a secret recruitment of hundreds of family members of top government officials that included Buhari himself, in violation of regulations. Nigerians widely urged Buhari to void the recruitment in favour of an open one, but he did not. The same chicanery, which has been in play at the Nigeria National Petroleum Corporation for decades, continues.

Also in 2016—and again reneging on a promise—Buhari redeployed, but never punished, the permanent secretaries who had padded the 2016 budget.

On the other hand, in June of that year, Buhari sacked more than 16,000 resident doctors and other specialists in the medical sector.

The point is that were we serious about making Nigeria’s medical sector attractive, the priority ought to be what it is elsewhere: professionalism and quality. Everyone ought to have confidence that the medical care he or she is about to receive is from a professional of the best quality rather than someone who merely has a powerful godfather.

This is what is missing, and it is what is chasing Nigerian medical professionals to seek employment outside the shores of the country.

In the public health domain, what is left is the frightening scenario of corrupt structures superintended by officials such as the budget-padders, and unqualified and unmotivated relatives of government officials such as the CBN hires.

How does this work, in practice? I offer two examples.

First, despite Buhari’s pretense of combating corruption, he has refused to publish the comprehensive and systematic list of looters and their loot ordered by the courts in the past four years.

Second: despite launching three parallel investigations into the stealing of funds of the Global Fund sent to Nigeria to combat disease, the Buhari government has in the same time frame failed to identify, let alone punish, one single official.

What this means is that this government is not telling the truth when it suggests that it is not responsible for Nigeria’s massive waste of funds on medical tourism. The government is the cause of the menace.

What is worse is that the problem extends to many areas. Take education, for instance. Two months ago, an article in the Carnegie Endowment for International Peace explained how politically-exposed West Africans, notably Nigerians, channel unexplained wealth into the UK education sector.

CBN Governor Godwin Emefiele has now admitted that the Buhari government pays about $80 million weekly, or nearly $1billion yearly, for overseas educational purposes. There is also extensive international concern about corrupt Nigerian money being funneled through Britain, with rich and powerful men and their wives under focus.

In other words, “prominent” Nigerians are not simply seeking health care abroad. They are doing so, and in the process choosing to ignore Nigeria and Nigerians who are worse off.

The challenge, today, is therefore the same as it was yesterday: for Nigerian leaders and officials to summon the courage to do something to change this story.

Nigeria needs care. It is official failure to appreciate this that has brought us to the breaking point.

This column welcomes rebuttals from interested government officials.