Africa loses an estimated $7 billion a year as more than half a million people leave the continent for medical treatment, BusinessDay reported, an outflow the paper tied to gaps in advanced care at home rather than to any single failing. The money follows the patients to hospitals in India, Europe and the Middle East, and it leaves behind health systems that cannot yet offer what those patients travel for.
Nigeria has long been the largest single contributor to that bill. The country spent between $1.2 billion and $3.6 billion a year on foreign healthcare at its peak, BusinessDay reported, most of it on complex conditions such as cancer, kidney disease, cardiac surgery and organ transplants. The Central Bank of Nigeria now projects that medical tourism spending could fall by up to 96 per cent by 2025, the paper said, a drop it credits to tighter foreign-exchange controls, rising treatment costs abroad and slowly improving care at home. Analysts still put the remaining outflow at hundreds of millions of dollars a year.
The drivers behind the outflow
The reasons patients leave are consistent across the continent, BusinessDay reported. Many African countries run one or two radiotherapy units for populations in the millions, and cancer care in particular needs pathology, imaging, surgery, chemotherapy and radiotherapy joined up in one place rather than scattered. Where those services are not available together, patients travel. A steady loss of oncologists, surgeons and medical physicists to Europe, North America and the Gulf thins the ranks further, and each departure makes the local option harder to trust. So the patients travel. They travel for cancer care, for heart surgery, for the scan their own city cannot run, and the money travels with them.
Cancer sits at the centre of the problem. Mansoor Saleh, founding director of the cancer centre at Aga Khan University Hospital in Nairobi, said the continent “lacks enough advanced treatment centres” for a disease burden that is climbing with population growth, ageing and urbanisation. BusinessDay reported that cases are rising faster than diagnostic and treatment systems can expand. Saleh said survival often turns on access to accurate diagnosis and modern therapeutics, resources that remain limited in many countries.
Building capacity at home
Against that outflow, some hospitals are trying to build the capacity that would keep patients on the continent. Aga Khan University Hospital in Nairobi has installed two TrueBeam linear accelerators, BusinessDay reported, machines that deliver targeted radiation and, with it, let clinicians treat some cancers in far fewer sessions. Angela Waweru, a consultant radiation oncologist at the hospital, said the systems allow radiation to be aimed with greater accuracy. The hospital has already treated hundreds of patients on the new machines, the paper said.
Rashid Khalani, the hospital’s chief executive, set the goal plainly: to keep African patients from having to fly out for care that can be given at home. The money “should remain in Africa and be reinvested” at home, Khalani said. He argued that reversing the trend would take more than equipment, and named the measures he thought were missing. Governments should meet the Abuja Declaration commitment to spend at least 15 per cent of national budgets on health, a target most have missed in the two decades since they signed it. They should pay doctors enough to keep them, and invest steadily in the machines and the laboratories that modern care depends on.
Kenya is trying the policy side as well as the capacity side. The government is restricting access to foreign currency for patients seeking treatment abroad when the same procedure is available at home, BusinessDay reported, a measure meant to conserve reserves and push patients toward local hospitals. Shaukat Abdulrazak, Principal Secretary for Science, Research and Innovation, said the country was investing in cancer treatment and research, and that its Social Health Authority programme now covered more than 29 million registered Kenyans, cancer care included.
The concentration problem, in reverse
Most medical tourism coverage watches destinations worry about where their patients come from. Africa is the mirror image, a source market large enough that its outflow funds other countries’ hospitals, and a set of governments trying to convert that spending into demand for care at home. That is a capacity problem before it is a policy one. The money leaves, and the care that would keep it at home does not yet exist. That gap is the drain the paper set out to measure, and it is a building problem before it is a budget one. Currency controls treat the symptom, the money leaving, while the strategy that actually holds patients is a cancer centre that can diagnose, operate and irradiate in one building. The same tension runs through the region’s other efforts, from Lagos mandating health insurance to the long-running pull of India over Nigeria’s outbound patients.
Abdulrazak put the stakes in human terms. “Behind every statistic, is a patient and a family struggling to access care,” he said.
What to watch
The test is whether the capacity now going in shows up in the outflow figures. Nigeria’s watchers should check whether the Central Bank’s projected 96 per cent fall in medical tourism spending appears in real numbers rather than forecasts, and whether the estimate of hundreds of millions still leaving holds or shrinks. In Kenya the measure is whether Aga Khan’s two accelerators and the Social Health Authority’s 29 million registrations cut referrals abroad. Across the continent the oldest test still stands: whether governments finally spend the Abuja Declaration’s 15 per cent, or leave it unmet for a third decade.
