Nigeria?s touted medical tourism narratives may be encouraging; however, this reverse migration is less of a triumph and more a patchwork stopgap. The Nigerian Medical Association has already warned that approximately $2 billion is still taken out of the country yearly as patients seek care abroad, a proof that the system remains fundamentally broken. GBENGA SALAU writes that unless rooted reforms in healthcare funding, infrastructure, and workforce retention are prioritised, this influx of diaspora doctors and inbound patients can become a fleeting distraction rather than sustainable progress.

In an unexpected twist to Nigeria?s long-standing medical tourism story, planes are now landing, not just taking off with patients. Persons who need medical care from across Africa and Nigerians in Diaspora are returing to Lagos, Abuja, and Port Harcourt to access treatments, which were once considered unavailable locally.

At the same time, Nigerian doctors who have built careers in the United Kingdom (UK), United States of America (U.S.A), and Canada are relocating to open clinics, perform surgeries, and invest in local capacity. This emerging trend of reverse medical tourism is not only changing where patients go, but also reshaping how healthcare is delivered in Nigeria, with homegrown solutions taking centre stage.

A testimony to this was the insight provided by Mrs. Rahmatallahi Awwal, who revealed that her husband pulled out his wisdom tooth for N200,000, yet it was supposed to cost him about 2000 Canadian dollars, which is over N2 million when the 2000 Canadian dollars is exchanged to naira.

Similarly, a Nigerian abroad also revealed that his friend in the United States recently was in Nigeria to fix his bad teeth for about $2000, but the cost was about $8000 in the United States considering how bad his teeth were.

Also, Dr Sunday Onuh, recently, said: ?We have seen people; who have done In Vitro Fertilisation (IVF) five times in the United Kingdom, and they just come here once, and they conceive and go back. This year in my practice alone, I have witnessed 40 per cent of patients from outside the country and the trend is similar with my colleagues because to do a successful IVF cycle in the US is about $20,000 but $6,000 will take care of transport, accommodation and treatment here.?

Also sharing her comment on a facebook wall during a discussion around reverse medical tourism, Onyemachi Chidera Esther, mentioned that the facility she works for, Eye Foundation Hospital, Ikeja, most of its patients come from the UK and America, especially to do their eye surgeries.

She revealed that one of the patients couldn?t get an appointment to see an ophthalmologist on time and by the time she came down to Nigeria, one of the eyes was completely blind.

Experiences like that of Obodo Chiazor, who did not reveal her location, but during a facebook interaction on reverse medical tourism, disclosed that she had an issue, which was not major in June 2023, but after all the tests were done, she needed to see a doctor, she was, however, booked in for February 2025, a staggering 20 months interval. The long wait like this is one of the reasons many patients abroad now see Nigeria as destination for medical care.

Thus, while there is no centralised national registry that tracks inbound patients, private hospitals in Lagos, Abuja, and Port Harcourt are reported to have about 10 to 15 per cent of specialist care patients coming from outside the country, with some from UK and America.

In Lagos alone, it is estimated that over 3,000 foreign patients sought care in private tertiary hospitals in 2023.

This, no doubt, is helping to reverse between $1.2 billion and $1.6 billion allegedly spent yearly on medical treatment abroad by Nigerians as revealed by the Ministry of Health in 2023.

Commenting on this new development of persons based abroad coming to Nigeria for medical care, the Managing Director and Chief Executive Officer of Nordica Fertility Centre, Abayomi Ajayi, agreed that there is a resurgence of people coming back to Nigeria for treatment. ?But let us not deceived ourselves, we are still not where we were.? He added that as a young doctor, including when he was undergoing training to become a doctor in the 70s, Nigeria was like the hub in West Africa for medical care.

?So, what led us to where we are, insufficient funding, not to talk of corruption that has affected the whole part of the country. But insufficient funding is a big problem,? Ajayi revealed.

He also said that poor funding fuels migration of health personnel because the moment healthcare is not well funded, people migrated, noting that the chairman of National Medical Advisory Committee (NMDC) recently said that only about 20 to 30 per cent of doctors stay back in Nigeria after training.

Also, a Nigerian doctor in the UK, who is a Cancer Research fellow, Dr Mathew Agwae, providing reasons for the reverse medical tourism in favour of Nigeria, said hospital appointments are easier and faster in Nigeria as the waiting times are often too long in western countries.

?Emergencies are given preference in western countries. For some special treatments, such as dental treatments, appointments are very hard and too expensive if you go to private health facilities. Many people, therefore, opt to return to Nigeria to have, for instance, their dental treatments done.?

For Founder, MakeOurHospitalWork Campaign and Public Health Policy and Management Specialist, Dr. Laz Ude Eze, reversed migration for medical tourism is actually not a new phenomenon, as Nigeria is a destination for patients in Europe and America whose treatment is delayed by a long waiting list.

He further said that the devaluation of naira has also made medical procedures cheaper for people abroad in a situation where out-of-pocket expenditure is required.

?Most of these returnees prefer private health facilities as they are considered more efficient,? he quipped.

And this reversal, experts are saying is happening because Nigeria is becoming an increasingly viable destination for inbound medical tourism, with strength in orthopaedic and cardiac surgeries, reproductive medicine (IVF, surrogacy), cosmetic procedures, advanced diagnostics and specialised minimally invasive treatments at rates that are friendly to the pockets.

They stated these services are catching international attention due to Nigeria?s combination of cost effectiveness, improving healthcare infrastructure, and competitive quality.

Ajayi, however, noted that most of the reverses being seen at present are private sector-driven.

?But we need many more, but more importantly, we need the people who are already doing that in the private sector to have access to funds to scale up,? he confessed.

Ajayi disclosed that those living in America, Australia, Canada, and other places are coming home to receive care because it is cheaper, and probably there is no waiting time. ?And what are they coming home for? They are coming for fertility treatment, dental and renal care, among others.?

He observed that It is the beginning of a good thing that should be maximised. And to maximise it, he said: ?The first thing is that the dichotomy between public and private hospitals healthcare has to stop. We have to be able to work together, not until signing PPP, but to see the health sector as one.?

It was revealed that over the last five years, more than 25 high-end private medical facilities have been established with diaspora funding or leadership.

Also, data from the Ministry of Health in 2021 indicated approximately 40,017 facilities are in Nigeria, with the private sector owned facilities comprising about 44 per cent of that figure. It should also be noted that faith-based facilities are often categorised as private.

The Chief Medical Director of Caring Habitat Skilled Nursing and Rehabilitation Centre, Dr Abdulfatai Olaolu Odemuyiwa, observed that Nigeria probably have enough infrastructure but the facilities need personnel and equipment to function.

He disclosed that In the development of Caring Habitat, the promoter encountered considerable challenges as the first facility of its kind in Nigeria, particularly with respect to explaining the hospital model to both patients and healthcare workers.

?Staff, notably nurses, require specialised training in wound care, operation of wound vacuum devices, bedside swallowing assessments, feeding tube management, and colostomy care, among others.

?Although comprehensive data on stroke incidence is lacking, the World Health Organisation estimates approximately 24,000 strokes occur yearly in Lagos, with mortality rates at 10 per cent within 24 hours; 30 per cent within a week; and 40 per cent within a month?primarily due to insufficient post-stroke care expertise and the absence of dedicated public stroke centers.

?Our multidisciplinary approach to stroke rehabilitation addresses the critical window following acute events to prevent long-term disability. Many families have repatriated loved ones from the USA and UK for both short and long-term rehabilitation, attracted by lower costs and the ability to maintain family contact and local dietary preferences.? Family vacation packages.

On his part, Eze said it is important that federal and state governments should create enabling environments for private health facilities to thrive. ?Policies unlocking the healthcare value chain should be optimally implemented. State governors should strengthen healthcare service delivery at the primary and secondary levels. It will help to decongest the tertiary facilities, (teaching hospitals) and enable them to focus more on their primary mandate: When this happens, it may become more attractive to medical tourists.?

Also, the Medical and Dental Council of Nigeria (MDCN) reported a 15 per cent increase in applications for temporary or special practice licenses by diaspora physicians between 2020 and 2024.

This is just as Nigerian-based telemedicine platforms like Dokilink, Tremendoc, and Mobihealth now employ diaspora doctors to consult Nigerian and international patients remotely.

The National Association of Nigerian Nurses and Midwives said that about 75,000 nurses have left the country since 2017, leaving the country to a ratio at one nurse to 1,160 patients.

Similarly, data from the Federal Ministry of Health revealed that Nigeria has lost not less than 16,000 doctors to brain drain in the past five years.

This is just as the Medical and Dental Council of Nigeria (MDCN) revealed that only 55,000 licensed doctors are available in the country to serve its over 200 million population, resulting in a ratio of one doctor to about 4,000 patients, a far cry from the World Health Organisation?s (WHO) recommended ratio of 1:600.

Between 2008 and 2021, a total of 36,467 Nigerian doctors migrated to the UK, rising from 1,798 in 2008 to 4,880 in 2021.

To drive processes that would make more health and medical personnel of Nigerian extraction to return home permanently or briefly to practice, Odemuyiwa stated that the healthcare delivery system in Nigeria is facing a significant crisis, necessitating immediate governmental acknowledgement and intervention.

?To address this challenge, it is essential to facilitate the reintegration of healthcare professionals from the diaspora by streamlining processes such as online registration where individuals can indicate their specialty and preferred practice locations. These professionals may then be matched with secondary and tertiary centers nationwide. Those who opt to serve in less urban regions would receive additional service credit compared to their urban counterparts, with compensation structured according to time served.?

Although in August 2024, Nigeria introduced the National Policy on Health Workforce Migration, offering incentives like tax breaks, housing mortgages, better supplies, and expanded training programmes to retain and attract professionals back home, there is still a lot of grounds to be covered.

Though the number of the returning medical and health practitioners is far small compared to those migrating, it is said that around 42 per cent of the returning doctors are reportedly filling specialist roles according to a Medical and Dental Consultants? Association figure, while 68 per cent of the returnees reportedly face delays in license validation, highlighting lingering bureaucratic hurdles.

From Odemuyiwa?s submission, Nigeria may need to do more. He said: ?One year of dedicated service could be recognised with a national honour, such as an OFR ? and a certificate of merit. Furthermore, establishing a Diaspora Healthcare Czar, functioning within the existing diaspora commission, would enhance coordination. Incoming experts will rotate across specialties to ensure comprehensive coverage, handing over responsibilities upon completion of their term. This initiative encompasses all healthcare disciplines including physicians, nurses, and various therapists.?

Odemuyiwa, who has spent 30 years working outside Nigeria, also suggested that science graduates who are currently unemployed may receive training for mid-level hospital roles, such as respiratory therapists or patient care technicians capable of performing tasks like phlebotomy and electrocardiograms.

?While some of these newly trained professionals may seek employment abroad, ongoing training efforts will eventually lead to workforce saturation.

?Combined with consistent and adequate compensation, these measures aim to gradually mitigate the effects of brain drain. Medication authenticity and streamlined importation of medical equipment ? minimising customs duties and bureaucratic obstacles ? are vital for fostering confidence in the healthcare system. Encouraging public officials to transparently utilise local clinics and practitioners, as exemplified by former Vice President Osinbajo?s recent surgery, can build public confidence. Outdated prohibitions on physician advertising should be eliminated to improve awareness of available healthcare services. Public funding for overseas medical treatment should be restricted, with expert panels reviewing applications for such care based strictly on clinical merit.?

On his part, Ajayi suggested that to maximise the opportunity, the government should make funding available and appropriately regulate the sector for quality assurance.

?Rather than being players, the government should make sure private sector players are funded, and the government should ensure that the funding is spent the way it?s supposed to be spent.?

He added that a World Bank study showed that in Africa, 60 per cent of the patients see doctors in private health sectors. ?So, there is no doubt that if we are going to get this right, the private sector has to be encouraged and funding has to be made available.?

Ajayi also argued that practitioners must understated that there is a business of medicine and practice of medicine. ?What we are mainly focused on is the practice of medicine, not the business of medicine. And that?s why our teaching hospitals are what they are,? he admitted.

?So really and truly, if we do it properly, healthcare is a profitable business, even for government, not only for private sector. We can employ so many people within the healthcare sector if the health system runs well. In America, healthcare is the greatest employer of labour. So we can, because healthcare is not only hospitals. There are diagnostic centres, pharmaceuticals, so many things are involved in it, but rolled into one. But all these are suffering now, mainly because of underfunding. So, for the positives to happen, political will of government has to be involved,? Ajayi insisted.

Speaking on the business opportunities of the new trend, a finance and data expert, Omotoyosi Ogunbanwo, said the government can help expand this as a tourist opportunity in many ways.

?They can remove visa requirements for foreigners coming to get IVF done with confirmed appointments. Mexico did this. The government can create a neighbourhood where qualified doctors can establish their services. I would give an example of Molar city in Mexico. This place is on the border of America and US. Every single building in this neighborhood is dedicated to dental work and post dental work care. It is the epicenter of dental tourism.

?How did Mexican government help? It provided visa free access to people going to molar city with the government offering tax free incentives many years ago to professionals.

?Mexican doctors who went to Ivy league universities in America moved back to Mexico and established their dentist clinics in molar city after this. And now this entire city has employed thousands of Mexicans. So, I promise you, there is a lot the government can do. Nothing can work without their support,? Ogunbanwo stated.

While also providing insight on how to make things work better, Odemuyiwa stated that outdated prohibitions on physicians advertising their trades should be eliminated to improve awareness of available healthcare services.

Odemuyiwa?s position is premised on the Medical and Dental Council of Nigeria (MDCN) Code of Medical Ethics that prohibits physicians and health practices from advertising services.

The code views such commercial promotion as undermining the dignity of the profession.

Yet a study discussing medical tourism pointed out that this advertising ban may hamper public knowledge of medical advances aside hindering local health facilities from marketing their services effectively. But, a few countries like the USA and New Zealand, allow physicians to advertise their services though it is strictly regulated.

Attempt to get Lagos State government, especially the Lagos State Health Facilities Monitoring and Accreditation Agency to speak to how HEFAMAA is working to Integrate private and public health sectors, and curb quackery considering reverse medical tourism is elevating Lagos as a regional care hub was not successful. Questions were sent to the Public Affairs Officer of the agency but no response yet as at press time.

Also, the federal Ministry of Health was contacted through the Director, Public Affairs of the ministry, he was yet to provide feedback to the questions sent to him on steps the ministry is taking to ensure that the country maximise the new opportunity.

However, as noted by experts, there is need for a clear vision by government on how to make the best of the health sector.

They said there is need for government to make adequate commitment to health, turning brain drain to brain gain, investment in modern innovations and research, effective stakeholder engagement with diaspora and foreigners who are willing to invest for a long time in Nigeria will be the way forward towards making Nigeria see the fortunes of medical industrialisation. (The Guardian)

Update news