Wapmuk, Sharkdam

Department of Research and Studies, Nigerian Institute of International Affairs, Lagos, Nigeria, sharksnaw@yahoo.com

 

Wapmuk, Agatha Eileen

Division of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria

 

Gbajabiamila, Titilola Abike

Division of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria

 

 

ABSTRACT

The paper examines the growing phenomenon of medical tourism in Nigeria-India relations. It discusses the evolving relationship between Nigeria and India and the growing presence of Indian investments in the Nigerian medical sector. The attraction of Nigerians to Indian hospitals is to seek quality and cost effective healthcare services. This has been necessitated by mismanagement resulting in the under-development of the health sector in Nigeria. India on the other hand has emerged as a major health provider because of its ability to offer ‘first-class treatment at Third World prices’. While India gains from inflow of a large number of Nigerian medical tourists, Nigeria loses from the outflow medical tourists due to the resultant cash flight. The paper also discussed the challenges of medical tourism sector in India. These include complex visa procedures, lack of insurance covers, poor airport facilities to carter for patients who arrive with critical conditions and accommodation challenges. Nigeria and India relations can be further strengthened for mutual benefits by expanding the partnership in the medical sector. The recent inflow of Indian medical centres into Nigeria, such as the Apollo Clinics, Primus hospital, Vedic Lifecare Clinic, Mecure Healthcare Services Ltd, amongst others, provides the foundation for expanding partnership in this sector. That notwithstanding the number of Nigerians visiting Indian for medical tourism remains huge. Accordingly, the paper concludes by recommending an increased role on the part of the Nigerian government in improving healthcare service delivery in the country. Considering the huge prospects in the health sector, the paper also recommends that Nigerian and Indian entrepreneurs should partner and invest massively in the provision of quality, affordable and accessible healthcare services in Nigeria.

Key Words: Medical, Tourism, Nigeria, India

 

1 INTRODUCTION

Medical tourism is a phrase that is commonly used to describe the phenomenon of foreign patients seeking healthcare in another country at better equipped hospitals and at medical fees comparatively cheaper than in their home countries. In other words, medical tourism refers to “visit by overseas patients for medical treatment and relaxation” (Shanmugam, 2013, p.1).The term medical tourism is anamalgamation of two distinct services - healthcare and tourism.The reality, however, is that it is difficult to associate the word tourism with chemotherapy, heart surgery, kidney transplant and other related treatment of cronic diseases. The World Tourism Organization (1999) defines tourists as people who "travel to and stay in places outside their usual environment for more than twenty-four (24) hours and not more than one consecutive year for leisure, business and other purposes not related to the exercise of an activity remunerated from within the place visited. From the above, it can be deduced that tourism involves particular activities selected by choice and undertaken outside the home. Accordingly, medical tourism has emerged as a form of travel activity undertaken for medical purposes and rest.

Compared to other forms of tourisms, namely leisure tourism, winter tourism, summer tourism and mass tourism; medical tourism, which is a form of adjectival tourism, is a recent phenomenon. Adjectival tourism refers to the numerous specialty travel forms of tourism that have emerged over the years, each with its own adjective. Many of these terms have come into common use by the tourism industry and academics. Apart from medical tourism, other examples of the more common emerging adjectival tourism markets include Agritourism, Culinary tourism, Cultural tourism, Ecotourism, Geotourism, Extreme tourism, Heritage tourism, Medical tourism, Nautical tourism, Pop-culture tourism, Religious tourism, Slum tourism, War tourism, Sex tourism, and Wildlife tourism (Gbadebo and Adedeji, 2013, p.13). Apart from these, other emerging forms of tourisms include sustainable tourism and space tourism, amongst others. It is beyond the scope of this paper to delve into these mentioned aspects of tourism in detail. That notwithstanding, it is pertinent to note that the medical tourism sector continues to growat an increasingly fast rate and has emerged as a major force for the growth of services exports, not only in India, but worldwide.Apart from India, countries like the United Kingdom, Middle East, Japan, U.S., Canada, Belgium, Costa Rica, Cuba,Dubai, Hungary, Israel, Jordan, Malaysia, Singapore, South Africa, Thailand and several others have emerged as active players in the medical tourism business.

India has emerged as major player in global medical tourism and has become the destination of choice for afflicted Nigerians who can afford to, or are compelled by fate of ill-health, to seek medical attention in that country. According to the Indian High Commission in Nigeria, 47 percent of Nigerians that visited India in the year 2012 did so to seek medical attention, while the remaining 53 percent did so for business, training, tourism and as students (Daily Independent Newspaper, June 6, 2014, p.3). The 47 percent of Nigerians that visited India for medical purposes amounted to 18,000 persons out of a total of 38,000 visas issued to Nigerians visiting India in 2012. The Nigerian medical tourists to India expended N41.6 billion (US$260 million) in foreign exchange in the process (Daily Independent Newspaper, June 6, 2014, p.3). The trend resulted from the inequality in access to healthcare and dearth of specialised medical facilities, which have remained a critical challenge to Nigeria’s healthcare provision.

The article examines the growing phenomenon of medical tourism in Nigeria-India relations. It also discusses the evolving relationship between Nigeria and India and the growing presence of Indian investments in the Nigerian medical sector. It is evident that the attraction of Nigerians to Indian hospitals is hinge on the desire to seek quality and cost effective healthcare services. According to Modi (2011, p.125), India is emerging as a global healthcare provider because of its ability to offer world-class expertise at developing world costs. In addition to the public health care facilities maintained by the Indian government and long standing well equipped private healthcare centres, recently, there has been a proliferation of new private healthcare facilities in India. Government support and increased investment in medical infrastructure facilities are some of the factors that have contributed to the growth of the industry in India. Other underlying issues that define the growth medical tourism in India are air connections and access to visa facilities. The paper is divided into seven sections. Following the introduction, the second section examines the concept of medical tourism. The third section focuses on the history, character and dynamics of Nigeria-India relations. The fourth section looks at medical tourism and Nigeria-India cooperation. The challenges in medical tourism in India are discussed in the fifth section. Section six focuses on medical tourism and inflow of Indian investment in the medical sector. Section seven is the conclusion.

 

2. THE CONCEPT OF MEDICAL TOURISM

Many scholars working on the subject have attempted to define medical tourism. Generally speaking, the term medical tourism is the act of travelling to other countries to obtain medical, dental and surgical care. According to Goodrich and Goodrich (1987), medical tourism is the attempt to attract tourists by deliberately promoting its health-care services and facilities, in addition to its regular tourist amenities. Laws (1996) defined medical tourism as a travel from home to other destination to improve one’s health condition as one type of leisure. This includes getting indigenous and alternative medical services, and any other form of tourism undertaken with the purpose of addressing a health concern. Connell (2006) describes medical tourism as a popular mass culture where people travel to overseas countries to obtain healthcare services and facilities such as medical, dental and surgical care whilst having the opportunity to visit the tourist spots of that country. Carrera and Bridges (2006) have defined medical tourism as travel which is systematically planned to maintain one’s physical and mental health condition. According to the General Agreement on Trade and Services (GATS), medical tourism is the second mode of trade in health services. In this mode, customers (patients) leave their home country to obtain health care services with high quality and affordable prices.

Blouin et al., (2006) and Monica (2007) argue that medical tourism occurs when international patients travel across boundaries for their healthcare and medical needs. It can be understood as provision of cost effective private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. Bookman & Bookman (2007) have defined medical tourism as travel with the aim of improving one’s health, and also an economic activity that entails trade in services and represents two sectors - medicine and tourism. Dawn & Pal (2011) introduced an interesting dimension to the discourse on medical tourism. According to these authors, medical tourism is looking for available quality combined with cost effective and low price health services while offering a similar level of safety to the patient.

In the past, the majority of medical tourists visited the industrialized countries of the world especially Europe, the UK, Middle East, Japan, U.S. and Canada, where the cost of medical treatment has become very expensive and there are often long waiting times for treatments. Over the years, the increased number of medical tourists including government officials, elites and citizens, who can afford the cost of travel, treatment and accommodation, travel to emerging economies to receive medical care. Medical tourists from the less developed countries, such as Nigeria, travelled to other countries to receive medical care, for other reasons other than just cost. In most cases, the quality of medical care is poor or lacking due to the collapse of medical sector in their countries. For most ordinary citizens, tourism is hardly the attraction, but their main aim is usually to seek medical attention in well equipped hospitals in foreign countries (Olukotun, 2013, p.1). Other than India, emerging countries that are currently promoting medical tourism are Thailand, Malaysia, Singapore, South Korea, Bolivia, Brazil, Belgium, Cuba, Costa Rica, Hungary, and Jordan. Also in context, private sector development in emerging economies, such as India, Thailand, Singapore, and certain Latin American nations, attracts foreign patients for relatively cheaper care: the uninsured, the underinsured, or those who prefer not to wait for treatment under a national health insurance system.

The dynamics of globalization has had its impact on the medical tourism industry. This construct of globalization in relation to medical tourism highlights the importance of the reduction of fees that time and space impose, and should warrant particularattention to the extensive role of the internet. Over one billion individuals have access to theinternet, and this number is growing daily. The internet is a trulyglobal forum for information dissemination, advertisement as well as a medical informationtransport device which has virtually no boundaries. Patients and doctors are able to converseand share information instantaneously; the internet provides a practically free avenue todeliver medical history, X-rays, and other complex tests via email, in addition tovideo conferencing and free online chatting. The patients’ primary care doctor at homecan converse with their surgeons abroad at little more cost than the doctors’ time.

Within the realm of the health sector, medical tourism is at the forefront of the globalization debate for various reasons. Firstly, most medical tourism sites exist within developing countries with high populations of poor and typically fewer healthcare professionals than demand requires. Secondly, many developing countries send hundreds or thousands of their citizens to the developed world for medical education, and these newly produced medical professionals remain in the developed world to practice. The combination of these two events leaves the developing world wanting more; hence the attraction of medical patients from the less developed countries to relatively more developed countries such as India.

 

3. THE HISTORY, CHARACTER AND DYNAMICS OF NIGERIA-INDIA RELATIONS

Historical exigencies, particularly, British colonialism brought the two countries into contact, with India becoming independent much earlier than Nigeria in 1947, while Nigeria became independent in 1960. The presence of a sizable number of Indians in Nigeria and Nigerians in India, which stood at about 35,000 and 5000 respectively in 2010, (Sachdev, 2011, p.1), is an attestation of this historical link. The Indian community has strong presence in Nigeria in the areas of trade and manufacturing, especially large departmental stores, textiles manufacturing, pharmaceuticals, paints, chemicals, engineering, banking, manufacturing, brewing, consumer goods and electronics. There are over 100 Indian companies that have established profitable technical and business ventures in Nigeria. These include Chellarams PLC, Bhojsons, Ranbaxy pharmaceutical company, Tata Automobiles, Reliance Communications, Airtel Barti Telecommunications, Bajaj, NIIT, Aptech, Indorama, Godrej, Primus hospital, Dana group, Stallion group, amongst others, which employ thousands of Indians and Nigerians. Their penetration of the Nigerian market has been facilitated by Nigeria’s free economy as opposed to India’s semi-closed economy.

Nigeria and India are important countries and both occupy strategic positions especially in their respective regions. This is apparently because of the sizes of their population, military, economic endowments, and roles and contributions in the international system. For instance India accounts for 75 percent of the population of South Asia, 65 percent of its total area and 78 percent of its Gross Domestic Product (GDP) (Singh, 2007, p.25). India with a population of above 1.2 billion people is the second most populous country in the world next only to China (Government of India- Census of India, 2011). Economically, India has a dynamic and highly competitive private sector which accounts for over 75 percent of its GDP. Its GDP was estimated at US$2.1 trillion in 2014-2015 and its average annual GDP growth rate stood at 6.1 per cent during 2011-2012 (IMF, 2014, p.2).

Nigeria stands out not only in West Africa, but also in Africa. Historically, Nigeria has played prominent roles at sub-regional, continental and global levels. With a population of 140,003,542 million people (National Populations Commission, 2006), Nigeria is not only the most populous nation in Africa and ranking 8th in the world, but also has the largest population of black people in the world. Nigeria’s annual Gross Domestic Product (GDP) in the year ending December 2013 was estimated at N80.3 trillion (US$509.9 billion), the highest in Africa, and the 26th largest economy in the world (Yemi, 2014, p.8). Nigeria’s exports were worth US$98.364 billion in the fourth quarter of 2013 (Economy Watch, 2013), which was far higher than most countries on the continent. The country produces 1.8-2.3 million barrels of crude oil per day, a major commodity which account for 95 percent of Nigerian export earnings come from oil (Munyama, 2009, p.5), and 65 percent of total government revenue (Aribisala, 2013, p.1). Nigerian oil reserves are estimated at 32-36 billion barrels, and in addition the country is among the most richly endowed in the world in terms of natural gas, with an estimated 100-188 million cubic feet of reserves (Statistical Review of World Energy, 2009). Nigeria is rich in solid minerals, and its land is suitable for agricultural production of a variety of food and cash crops. Nigeria has the largest, best equipped and trained armed forces in the West Africa.

Badejo (1990, p.88) notes that factors such as English language, governmental procedures, anti-colonial struggles as well as contemporary interests, necessarily brought the two countries into contact, interaction and cooperation. Both countries have diversities of religions, cultures, and languages. Both countries played active roles in the Commonwealth of Nations, as well as Group of 77 (G-77), Non-Aligned Movement (NAM), and Group of 15 (G-15). They are also members of the Asian-African Legal Consultative Organisation (AALCO), Afro-Asian Rural Development Organisation (AARDO). Both countries have demonstrated support for anti-colonial and anti-apartheid struggles and have been visible at multilateral platforms such as the United Nations (UN) and the World Trade Organization (WTO) and have actively supported the reform the world body and the demand of a new economic order. Both countries have demanded deeper participation of developing countries concerning critical issues on the global agenda such as climate change, the Doha rounds and the need to curb the spread of terrorism (The Guardian, October 15, 2007).

The relationship between the two countries has been strengthened at the political level through exchange of visits by political leaders. In the first 40 years of Nigeria’s independence, there were two official visits from an Indian Prime Minister to Nigeria (Vasudevan, 2010, p.11). The first visit was by India’s first Prime Minister Pandit Jawaharlal Nehru in September 1962, while the second was by Prime Minister Manmohan Singh in 2007 from October 14-17, 2007 during which, the Abuja Declaration on strategic partnership between India and Nigeria and other Memoranda of Understanding were signed. Among the Nigerian leaders that have visited India are: President Shehu Shagari who was guest of honour at India’s Republic Day Celebrations in January 1983; Brigadier Tunde Idiagbon and Commodore Augustus Aikhomu, on 2nd November, 1984 to attended the burial of former Prime Minister of India, Mrs Indira Gandhi; and President Olusegun Obasanjo who was a guest of honour at India’s Republic Day Celebrations in January 2000. During Obasanjo’s historic visit, he assured the Indians that Nigeria would soon be Africa’s ‘most lucrative market’; enabling India to access other West African markets as well (The Hindu Newspaper, 27 January 2000). Similarly, during the third India Africa Forum Summit held from October 23-29, 2015, President Muhammadu Buhari, who was among the 54 African leaders invited to the summit, assured heads of industries in Nigeria and prospective investors in New Delhi, that his administration will fight corruption and create a stable business environment for all businesses in Nigeria.

At the economic level, the two countries had been interacting even before Nigeria’s independence in 1960. The Indian company known as Kishinchand-Chellarams (now Chellarams PLC) was established in Nigeria since 1923. Trade between the two countries was estimated to have reached US$16.3 billion in June, 2015. While exports from India stood at US$2.68 billion dollars, imports from Nigeria, which comprised mainly crude oil, stood at US$13.68 billion (Leadership News, June 6, 2015). Indian investment in Nigeria is estimated to be over ten billion dollars (Sachdev, 2014, p.181). It was also reported that India, with an investment of US$5 billion, was the largest investor in Nigeria in 2010 (The Punch, 12 August, 2011, p.20).

Indian entrepreneurs’ presence in the Nigerian economy is well diversified and does not easily subject itself to stratification. However, Indian investment in Nigeria can be compartmentalised into three broad categories on the basis of the source of investments. These include: India-based (Tata and Airtel), by Nigeria-based Indians (Dana Group, Chanrais, and Chellerams) and by third country based Indians (Indorama). The current Indian entrepreneurial presence in Nigeria touches virtually all aspects of the Nigerian economy, even as its relative strengths are uneven. Although many of the Indian ventures are concentrated around Lagos, Indian enterprises are present in many Nigerian states as well. In terms of numbers, the pharmaceutical sector dominates with over 30 establishments, followed by healthcare, steel smelting (from scrap) and consumer products. In terms of size of investments, Airtel Nigeria currently has the highest investments with an estimate of about 4.5 billion US dollars. The major Indian investments in Nigeria comprise of Airtel, Indorama, various groups of Channai family, Sterling Energy, Dana group, Stallion group, Mehtanis, Chellarams group, Bajaj, Tata, Godrej, NIIT, Ashok Leyland, Skipper, Simba and Primus amongst others.

Another meaningful and enduring relationship between Nigeria and India is in the area of military cooperation which dates back to 1961 (Kura, 2009). Over the years, the Nigerian armed forces have benefited from the various forms of military assistance by the Indian government. Particularly, the Indian government helped in the building of the military institutions, including the Nigerian Defense Academy (NDA) in Kaduna and the Command and Staff College (CSC) Jaji in Kaduna (Isa, 2008:59; Kura, 2009:14). The Indian government has also provided scholarships under the Special Commonwealth African Assistance Plan (SCAAP) (Pham, 2007a:53). The annual number of scholarships to Nigerian students for studies in India has also been increased from 50 to 75. In fact two former Nigerian Heads of State, General Olusegun Obasanjo and Ibrahim Babangida received military training in India. In 1997, 10 out of the 36 Military administrators received military training in India (Isa, 2008:59).

Notwithstanding some commonalities between them such as historical experiences of underdevelopment under British colonialism as well as diversities of religions, cultures, and languages, India’s determination to break away from underdevelopment and dependency has led her to emerge as a developed and a destination country for medical tourism. It is within this context that we can understand India’s quest for increased engagement of countries with resource endowment and large markets such as Nigeria.

After it introduced an economic liberalization programme in 1991, India’s foreign policy shifted from Gandhian and Nehruvian principles and rhetoric of south-south, nonalignment etc to focus on pragmatic economic diplomacy. This shaped its relations with African countries as well. India began to view Africa through a strategic lens and realized that economic engagement with African countries could serve its national interests. Africa’s rich energy resources were attractive for a rapidly industrialising India. India has since then used economic diplomacy as a method of engaging African countries, including Nigeria. In 1993, the Indian government stated that, ‘in the future, new relationships based on concrete economic, technological, educational cooperation will assume significance’ (MEA, Annual Report, 1992-1993, 55). Indian officials also emphasised that the orientation of India’s foreign policy is designed to promote ‘enlightened national interest’ (Beri, 2011, 1). At the same time, Indian policy makers pointed out clearly that energy security is an important element of India’s foreign policy, particularly in the context of the developing world. According to the Indian Prime Minister, Manmohan Singh, ‘our concern for energy security has become an important element of our diplomacy and is shaping our relations with range of countries across the global, Africa, West Asia, and Latin America’ (Beri, 2011, 1).

India has, in recent times, made severalefforts to engageNigeria and other African countries, with an interest motivated by geo-economics, especially in terms of resources.While some have interpreted the phenomenon of India’s increased engagement of Nigeria in the light of a new scramble for Africa’s resources and markets, others see it as a continuity of a relationship in the light of old ties such as in the days of the Nonaligned Movement, anti-colonial struggle and in the spirit of South-South cooperation.The first was held in New Delhi in April 2008, and the second was held in Addis Ababa in 2011 and the third was held in 2015. The first two summits witnessed a serious strategic push from the Indian government to strengthen its ties with African nations. The cooperation framework adopted at the 2008 Summit outlines the priority areas of future cooperation which ranged from capacity building, agriculture, infrastructure development, health food security, energy security and technology cooperation.

The 2011 Summit sought to enhance partnership between Africa and India for the mutual benefits. Both partners agreed to assist each other to achieve inclusive growth, socio-economic development and self-reliance. Areas for such cooperation outlined included sharing strategies for sustainable development, poverty alleviation, healthcare and universal education, and sharing appropriate technologies. Although several issues were highlighted during these summits, however, the desire to ensure energy security is seen as the dominant interest in India’s policy towards Africa today. From October 26 to 29, 2015, India hosted the third India-Africa Forum Summit (IAFS III), which had in attendance representatives of 54 countries, with 40 Heads of State or government. Originally scheduled for December 2014 but postponed because of the Ebola crisis, IAFS III was a spectacular event. African Heads of state as well as representatives from the African Union (AU) and continental bodies like the New Partnership for Africa’s Development (NEPAD) agency were in attendance at the meeting in New Delhi.

In lined with the theme of the IAFS III, which is ‘Invigorated Partnership: Shared Vision’ the Indian government offered additional concessional credit of 10 billion US dollars under concessional lines of credit (LOC) over the next five years. That was double the US$5 billion announced at the 2011 summit. This is an addition to the ongoing credit programme. It also offered a grant assistance of 600 million US dollars, which includes an India-Africa Development Fund of 100 million US dollars and an India-Africa Health Fund of 10 million US dollars. It also included 50, 000 scholarships in India over the next five years. In addition, India pledged to support the expansion of the Pan African E-Network and institutions of skilling, training and learning across Africa. The problems with the LOCs are well documented including a widening gap between sanctions and disbursements. In a pre-summit media briefing in New Delhi on October 17, Secretary (West) in the Ministry of External Affairs, Navtej singh Sarna, gave an update on LOCs. On the US7.4 billion offered before 2015 summit, US6.8 was approved and only US3.5 billion had been disbursed. In effect most African countries were unable to access the LOCs promised. Both India and recipient African countries are responsible for the low disbursement of the LOCs. In India, a multi-tiered and multi-agency framework for sanctioning and disbursing these loans creates delays. Additionally, a non-transparent process engenders attendant distortions. Exim Bank, which finally disburses the loans, has complained to the Prime Minister of India’s office about malpractices (Singhal, 2015: 3). On the African side, capacity gaps in drawing up detailed project reports essentially for the Indian side to conduct a proper appraisal and assessment caused enormous delays. Nigeria is one of the countries that have not been able to access the US$100 LOCs promised during the visit of Indian Prime Minister, Manmohan Singh to Nigeria in 2007. The complaint from the Indian side has been lack of transparency and accountability. On the Nigerian side, there have been complains of lack of cooperation from the Indian government. That notwithstanding, during the IAFS III in 2015, the Indian government promised to review the implementation of, and progress, areas of cooperation and identified projects.

There are many dynamic considerations why the Indian government is increasing its engagement of key African countries such as Nigeria. At the forefront of India’s foreign policy priorities as from the 1990s is energy security (Obi, 2010, p.187). The Indian economy has grown rapidly from the 1990s, and securing cheap energy and other strategic raw materials as well as markets on a long-term basis has become an economic and political imperative. It is projected that by 2030, India will be the world’s third-largest consumer of energy. Currently, 75 percent of India’s oil imports come from the politically volatile Middle East. Notably, because India possesses few proven oil reserves, diversifying the sources of its energy supply by developing stronger economic ties with the African continent tops the political agenda. With projections suggesting that India will depend on oil for almost 90 percent of its energy needs by the end of this decade, it is little wonder that energy security through the diversification of supplies is a key priority. Given Africa’s position as the last oil frontier, and Nigeria as Africa’s largest producer of oil, it is only strategic that India engages the continent, and Nigeria, in particular, in the pursuit of her energy security interests. This urgency is further elevated by the increasing scramble for African resources and markets by India, China and the industrialised countries of Europe and America. Nigeria has also become a major attraction to Indian oil companies in recent years because its oil is of high quality, being low in sulphur.

Secondly, Nigeria, given its huge population and the strategic size of its economy now the largest in Africa, has emerged as an important market for Indian goods and services, as well as tourism industry of which medical tourism is currently a major attraction for Nigerians. In this regard, the Indian private sector, with sufficient government support, has been active in expanding trade and investment in Nigeria to capture its market potential. Indian hospitals either directly or through agents have reached out to Nigerians promising ‘first-class treatment at Third World prices’. Similarly, as a developing country, Nigeria is also interested in drawing lessons from the Indian experience, having moved up from an industrially underdeveloped state. It is also interested in drawing lessons from India’s experience in the areas of information and communications technology, agriculture, pharmaceutical and medical sector, as well as small and medium scale enterprises, with its huge potential for employment generation in Nigeria (Ashiru, 2012, p.3).

While acknowledging the fact that India has its own share of development problems including, high rates of poverty, unemployment and corruption, there is no denying the fact that India has moved up the development ladder. India has made achievements in the areas of industrialisation, scientific and technological capabilities, advances in information and communications technology (ICT), as well as medical sector from which Nigeria could benefit immensely. Strengthening relations between the two countries becomes even more imperative since both nations are looking for avenues to promote their interests in an increasingly changing and interdependent global environment.

 

4. MEDICAL TOURISM AND NIGERIA-INDIA COOPERATION

The reasons for the increase of Nigerians going for medical tourism in India are many. First, years of systemic decay by a lack of political commitment, corruption and mismanagement of the national economy has also affected the health sector. The political leaders inclusive lack confidence in healthcare facilities established by them and prefer to go abroad for treatment. Aside the lack of confidence in the health sector, the then President of NMA, Dr Osahon Enabulele, argued that the major reason for the medical pilgrimage, includes persistent negligence and under-development of the health sector, especially under the military era; poor funding and out-of-pocket financing of the sector; declining quality of medical personnel occasioned by dwindling standards of education. Secondly, with the Nigerians preference for anything foreign, it is not surprising that over 5,000 citizens fly out on a monthly basis, seeking medical treatment in India and other countries. According to the Nigeria Medical Association (NMA), while Nigeria loses over US$500 million annually, India gains about US$260 million of the resultant cash flight. Buoyed by the boom of its medical tourism due ostensibly to Nigerians’ patronage, India’s projection for the year 2014 was to realize a huge sum of between US$1bn and US$2bn from a medical tourism market worth over US$20bn (Shanmugam, 2013).

At all levels of government, local, state and federal, there are many contributing factors. These factors make subjecting result to treatment in any Nigerian hospital an avoidable risk. The late activist, Gani Fawehinmi was diagnosed in Nigeria of Malaria was treated of same several times, only to discover that it was cancer, when he travelled for treatment abroad (The Punch, June 26th, 2014). Unfortunately the right diagnosis was made too late to save him. The same fates that befall several Nigerians go unreported in the country. The irony is that most of those Nigerians who can afford to spend between US$20,000 and US$50,000 on an average trip abroad for medical treatment may end up being treated by fellow Nigerians, who back home, would not have been as efficient and prominent as they have become in a foreign land.

The main reasons for the growing popularity of medical tourism in India include the long waiting lists in the developed countries; low cost of medical treatments in India as compared to other developed countries. Table 1 provides Cost Comparison between India, USA, Thailand, and Singapore US dollars.

Table 1: Cost Comparison between India, USA, Thailand, and Singapore (approximate figures in US$)