There has been a raging debate surrounding the state of our healthcare systems in Africa. More than once, Africans have denounced the tendency of the elite class to seek healthcare in developed countries instead of building the needed infrastructure at home. In other instances, an increasing number of our people have sought medical care in countries such as India, prompting Africans to ask themselves why the continent cannot become the beneficiary of medical tourism as well. This is as much a health issue as it is an economic one. Medical tourism subscribes to the logic that seeks to position Africa in higher value chains of the world economy. However, for the continent to become a destination for medical tourism, Africa’s strategy must aim at solving the iron triangle equation of every healthcare system: cost, access, and quality. The goal is to cover Africans first. Then, and only then, would Africa begin to attract foreigners.
Any major accomplishment in a sector as big as healthcare and on a national/continental level cannot be achieved by luck; solving the healthcare conundrum and making Africa a destination for medical tourism must be a thoughtful, intentional and purposeful leadership strategy that is keen on investing and facilitating investments in three main axes: local medical education; local manufacturing of open-patented drugs, vaccines and health equipment; and collaboration among African (healthcare) stakeholders.
There has never been any aspiration to medical tourism without an effective local healthcare workforce. Providing medical education, even up to the level of medical specialities, should be the preoccupation of every African country, and this is for the benefit of our people. This requires a substantial public investment as it is a long-term and costly endeavour. Training healthcare professionals on subsidized public loans to be repaid by working for the government has been a traditional realistic healthcare (self-) financing solution that gives access to healthcare-related education to people who would otherwise not have access at all. At the same time, this strategy reduces costly processes such as Africans travelling abroad for medical care. Adequate health coverage requires decentralizing medical education and infrastructure so as to bring basic and specialized medical care to the population rather than waiting for them to come for it. Only thoughtful leaders can operationalize such a system.
Second, and equally important, Africa must insist on locally manufacturing healthcare equipment. The Covid-19 pandemic has taught us the value of local manufacturing in terms of coverage and fast accessibility to essential medical drugs and equipment. Furthermore, local manufacturing has a considerable cost-effectiveness impact on product availability as it removes the importation cost and bottlenecks. Public-private partnerships are vital to achieving an effective healthcare system and medical tourism. Tax exemptions and land donations could be some of the major advantages the government can give to local health entrepreneurs, including medical universities, pharmaceutical companies, hospital chains, etc.
Additionally, in this process, inter-African collaboration must be understood as the creation of platforms to share research findings, exchange knowledge and skills and expand health business opportunities. Among other things, these platforms could stop, or at least reduce, the damaging effects of the hemorrhagic brain drain of African health minds, which has been happening for decades. In this regard, there is a quantifiable financial cost of African doctors leaving sub-Saharan Africa. For instance, according to the British Medical Journal, “Africa experiences 24% of the global burden of disease, yet it has only 2% of the global supply of doctors and less than 1% of expenditures on global health.”
Lessons from elsewhere
Medical tourism in India has been the subject of numerous case studies in the world. It has been growing at a rate of 30% a year and is currently estimated to be worth US$ 5-6 billion with a growth projection up to US$13 billion by 2022.
In addition to investing in advanced facilities and training healthcare providers, the Indian government through the Tourism Ministry and the Ministry of Health and Family Welfare developed medical visas (M-visa), which allows medical tourists to visit India for a specific period or multiple entries if necessary. Most private hospitals have used the M-visa to their benefit by expanding their medical packages to include travel and accommodation cost discounts for medical attendants. The affordability of Indian specialized medical care mainly derives from an efficient locally trained health workforce, locally manufactured drugs/high-end equipment, and government facilitation/incentives.
To illustrate the impact local drug manufacturing has on patient care, India manufactures generic pharmaceuticals at a much lower cost compared to most countries in the West. For example, Cipla pharmaceuticals, one of the largest Indian pharmaceutical firms, reduced the cost of HIV/AIDS antiretroviral medications to less than a dollar per day, cutting the cost of antiretroviral (ARV) drugs per person from around $12,000 to less than $365 per year.
On top of providing a digital healthcare platform for medical care seekers that includes travel and hospital-related information, India’s Ministry of Commerce and Industry has gone an extra mile to ensure that healthcare partnerships are established with Africa in 2002 through its Focus Africa Programme, which includes access to pharmaceutical products, among other trade items.
The South African government, on the other hand, has realized that there is a huge demand in intra-regional South-South medical tourism, far more significant, in terms of numbers and money, than the North-South movement. These movements have primarily been between private medical institutions that refer complicated cases or people who travel individually in search of medical care to medical institutions/facilities where they can get help. This large influx of informal medical tourists, particularly from neighbouring countries, compelled the South African government to establish agreements for medical travel to its public hospitals and clinics via inter-country agreements in order to recover the cost of treating non-residents.
Although there is still room for improvement, South Africa along with Kenya and Ghana are good examples of inter-regional medical tourism attraction as they play a major role in their respective regions.
The major factors contributing to robust medical tourism are varied, ranging from political stability to travel facilitation. They also include public and private health infrastructure investment, international accreditation and quality standards, low-cost medical procedures, social security and stability, good tourism infrastructure, healthcare innovation and advanced medical technology, experienced staff, among many. These can only be achieved under an atmosphere of clear political will.
Dentistry, cosmetic, orthopaedic and cardiovascular surgery; cancer treatment; reproductive and specialized scans and tests; health screenings; and second opinions are among the most sought-for specialities for medical tourists around the world.
For the most part, medical tourism relies on the ability of tourism providers/countries to optimize the patient’s experience throughout their already difficult medical journey. An online presence, fast medical visas, the cost of the medical packages, travel costs, hospital stay, surgery fee, and companion’s accommodation cost are some of the basic factors that impact medical tourist attraction.
Healthcare is indeed not just about health; it is an integral part of the economy. And the sooner African leaders understand this, the closer the achievement of attractive medical tourism in Africa will be.