A few days ago, Nigerians received the sad news of the death of its former President, Mohammadu Buhari, at the age of 81 years. He had led the nation both as a military Head of State from December,1983 to August,1985, and more lately as elected civilian President from 2015 to 2023.
Whatever controversies may have been occasioned by his rule, the prevailing mood of the nation, appropriately, is to mourn of his demise, and pray that Allah (SWT) may forgive his shortcomings and accept his soul in Aljannah Firdaus.
This is also an appropriate time to consider the implications of a widely prevalent situation pertaining to the nation’s healthcare system, and deliberate on the requirement for urgent and intentional efforts towards remediation.
Nigeria’s former President travelled to the United Kingdom before his death, and was receiving treatment in a health facility in the country up till the moment of his passage into glory. Even during the period of his incumbency, he had at various times travelled to the same country and spent various lengths of time receiving treatment.
This is not new. Rather it is the observed routine among the leadership and elite of the nation.
One of the bounden duties of any nation is to look after the health of its citizens. There is an even greater imperative that the nation look after the health of the people who are entrusted with positions of authority, so that they may be optimally enabled to perform the onerous duty of piloting the ship of State in the right direction. If the reality, as seems evident from the body language of present and past leaders, is that the nation is failing in the performance of this very important duty it owes to its leaders, the implications are legion, as will be seen later. But the interpretation of that reality may be two-fold – that the healthcare facilities in the nation are not good enough to perform their assigned function, or that there is a lack of trust in their ability perform the duty. From a management perspective, it is necessary to look closely at these two possibilities, because they dictate different prescriptions for remediation. If facilities are not good enough, the situation can be addressed by intentional improvement to meet a prescribed ‘international’ standard. If the issue is more of a lack of trust, remediation is more difficult and nebulous, requiring a collective effort at psychological reorientation.
A Long History of Medical Tourism at the Top
Nigerian leaders have sought medical treatment from foreign healthcare facilities from as far back as most citizens can remember. Many would recollect the extended admission of military President Ibrahim Babangida in a hospital in France during the period when ‘Radiculopathy’ first emerged into the lexicon of the Nigerian public. Late President Umaru Musa Yar’Adua spent months in a Saudi hospital before his death in Nigeria in 2010. President Goodluck Jonathan made a quiet trip to Germany in 2014 for what might have been medical reasons. Olusegun Obasanjo, during his presidency, reportedly took unannounced trips abroad for medical reasons, too.
President Bola Ahmed Tinubu has continued the tradition of taking health-related trips abroad.
Lower down in the public service hierarchy, it is a well established practice for Governors, Legislators and other functionaries to seek medical treatment abroad for major or minor health conditions.
A few cases have bucked the trend, some of which have been for the purpose of intentionally setting example, but others which have been due to an absence of other actionable options.
Vice President Yemi Osinbajo made headlines in 2022 when he underwent complex orthopaedic surgery at Duchess International Hospital in Lagos. His decision was lauded as courageous and symbolic, a show of confidence in Nigerian healthcare.
Alhaji Abba Kyari, President Buhari’s Chief of Staff, sadly died in the intensive care facility of a Lagos hospital during the COVID-19 pandemic and lockdown of 2020.
A Global Comparison: How Other Leaders
Why Do Nigerian Leaders Prefer Foreign Healthcare?
Multiple systemic shortcomings in Nigeria’s healthcare system push leaders (and many citizens who can afford it) to seek treatment overseas. Key factors that erode confidence in domestic healthcare and make foreign options attractive to public officials include the following:
Quality of Care and Equipment: There is a widespread belief that Nigerian public hospitals often lack modern equipment and consistent quality of care for complex conditions. This perception does not take cognisance of the changes that have taken place in the past few years, with the increasing participation of the private sector in healthcare finance and operation, and an increasing focus on seeking institutionalised Quality Improvement and Accreditation in some private and a few public facilities across the nation.
Human Resources and “Brain Drain”: Nigeria faces a shortage of skilled medical professionals, worsened by the exodus of doctors and nurses to greener pastures abroad. Approximately half of Nigeria’s licensed doctors practice outside the country . The World Health Organization estimates Nigeria loses 2,000 doctors every year to migration (mostly to the US, UK, Canada) . This brain drain leaves gaps in specialized fields – for example, there are only a handful of oncologists or neurologists for a population of 200 million.
Overall, Nigeria has about 1 doctor per 5,000 people, far below the WHO-recommended 1:600 ratio . Many top Nigerian doctors can indeed be found – but in London, Houston, or Johannesburg, not Lagos or Abuja. Signigicantly, when the new African Medical Centre of Excellence in Abuja (a private international hospital opened in 2025) began recruitment, they found that “the very best [candidates] frequently were Nigerian doctors and nurses” – who were working abroad .
Infrastructure & Funding Gaps: Many Nigerian hospitals suffer from poor infrastructure maintenance and inadequate funding for operations. It is common to hear depressing stories of surgeries being done by flashlight due to power outages, or patients’ families scrambling to buy oxygen and medications because a hospital’s pharmacy is empty. Basic amenities may be lacking or deficient. For instance, oxygen shortages and malfunctioning generators have led to preventable deaths in some public hospitals. Although Nigeria allocates hundreds of millions of dollars to health in the budget, the budget is inadequate to meet existing needs, and some of it undoubtedly is eaten up be inefficiency and corruption. A vicious cycle ensues – underfunding leads to declining quality, which leads those with means (including public officials) to avoid local hospitals, further eroding political will to invest in them. As African health scholar Ejike Oji observed, “leaders maintain a vicious cycle which keeps faith in public healthcare low while channeling substantial state resources to hospitals abroad rather than plug local gaps.” .
Frequent Strikes and Unstable Services: Nigeria’s healthcare workforce is plagued by industrial actions affecting public health facilities. Strikes by doctors and nurses in public hospitals happen regularly due to unpaid salaries, poor working conditions, and low wages.
During such strikes, services are brought to a halt, sometimes for weeks – an unacceptable risk if a high-profile official needs continuous care. These recurrent disruptions make officials doubt that they could get reliable treatment at home, both for acute care and conditions.
Privacy and Political Secrecy: Another factor is the desire for ‘privacy’ (secrecy) regarding the health status of public officials, especially those occupying the highest offices. There is often an intentional cloak of secrecy surrounding the health status of Nigerian leaders. The stark reality is that the ‘privacy’ sought abroad may be more illusory than real, and the possibility of the health records of a nation’s leaders becoming available to the security agencies of another nation should itself be seen as a national security concern that is not often considered seriously in the Nigerian situation.
Perception, Lack of Trust, and a Legacy of Neglect: There is a deep-rooted perception that “Western hospitals are better.” Decades of Nigeria’s own leaders deriding or neglecting local hospitals have reinforced public belief that any health chsllenge considered significant should be treated abroad if possible. This mindset affects leaders themselves – many of whom have personal physicians overseas or long-standing relationships with hospitals in London, Dubai or New York.
Historically, Nigerian administrations have promised to ‘fix’ healthcare, but they have delivered little. Politicians frequently campaign on improving hospitals, yet once in power they too seek care abroad, sending a message of “Do as I say, not as I do.” President Buhari, for example, campaigned in 2015 about ending medical tourism by officials . However, once in office, he continued the practice, in the process further undermining public faith in the nation’s healthcare. This persistent “medical tourism” at the top has engendered cynicism: why would ordinary citizens trust a system that the elite pointedly avoid? As Africa analyst Yomi Kazeem noted, after years of this behavior, Nigerians have seen “a long history of failed promises” on health, and few expect officials to change unless compelled . Indeed, during the 2020 pandemic when borders were closed, a Nigerian doctor quipped that once the crisis passed, “we will return to status quo” – implying leaders would resume flying out for healthcare at the first chance.
In sum, Nigerian leaders prefer foreign treatment because local healthcare is perceived as unreliable, under-equipped, under-staffed, and even dangerous for advanced care. These systemic issues – from infrastructure failures and brain drain to trust and privacy concerns – create a strong incentive to go abroad, despite the high financial and ethical costs. It is a paradox that a country as wealthy and populous as Nigeria, which spends significant sums on medical budgets, sees its VIPs routinely check into London or Dubai hospitals for ailments as simple as an ear infection. This speaks to a governance failure that has persisted across administrations.
Key observations from global comparisons:
Developed Countries: Here, it is standard (and expected) that leaders use domestic healthcare facilities. The facilities available (e.g. the Mayo Clinic in USA or Germany’s Charité Hospital) are world-leading. Public opinion would strongly criticize a leader who didn’t trust their own country’s system. Moreover, security and logistics favor staying in-country. When U.S. President Ronald Reagan was shot in 1981, he was rushed to a Washington D.C. hospital and famously quipped to the surgeons, “I hope you’re all Republicans,” underscoring that he never considered leaving the country for care. The political norm is set: a leader must lead by example in using local healthcare, which in turn is well-funded to meet that duty.
Emerging/Developing Countries, and ‘Underdeveloped’ Countries (LMIC): Many have significantly improved their healthcare in recent decades, developing centers of excellence. India’s top government hospitals regularly treat not only Indian VIPs but also medical tourists from Africa and the Middle East. It is a matter of pride that an Indian Prime Minister would use an Indian hospital; indeed PM Modi often publicly praises India’s doctors and has launched schemes to further upgrade facilities. Brazil’s presidents similarly use Brazilian hospitals – e.g. after the 2018 assassination attempt, President Jair Bolsonaro had multiple surgeries at Albert Einstein Hospital in São Paulo, and was not flown abroad. These countries demonstrate that, with investment, a developing nation’s healthcare can earn and retain the trust of its leaders. There is also a political calculus: leaders of large nations like India or Brazil rarely want to appear dependent on former colonial powers for their wellbeing – it would be seen as a national humiliation. This contrasts with Nigeria, where unfortunately it has become normalized for officials to dash off to London for “medical vacation.”
Unfortunately, in the poorest nations, it is often a tale of two extremes. Some leaders follow the Nigerian model – going abroad for the slightest ailment because local hospitals are in disrepair, or because they do not trust them. Others, usually driven by populism or poor finance, would stick with local care. Tanzania’s former President Magufuli is an intriguing case: by forbidding foreign medical travel, he forced the elite to use Tanzanian hospitals, presumably to motivate improvements. Indeed, during his tenure, there were reports of increased funding to local facilities, and he sought help from foreign specialists by bringing them into Tanzania rather than sending patients out. On the other hand, critics note that when Magufuli himself fell gravely ill in 2021 (reportedly of COVID-19), his government was so secretive in their handling of the situation that it was unclear if he truly stayed in Tanzania to receive his care or was quietly flown to Kenya, where he ultimately died.
Rumours swirled around that his avoidance of foreign hospitals may have cost valuable time and reduced his chances of survival. This illustrates the risk of pursuing national autonomy in healthcare in situations where local capacity is not genuinely up to par.
In stark contrast to President Magafuli’s example, the late Zimbabwean President Robert Mugabe (one of the longest-ruling leaders in Africa) openly sought care abroad for decades, with frequent well publicised flights to Singapore. He did not trust his country’s healthcare system to look after his own health.
Nigeria is close to this negative end of the spectrum, despite its potential wealth as nation; like Mugabe, Nigerian leaders have so far been unwilling to stay home for treatment, reflecting a lack of confidence in their own system.
Conclusion and Recommendations
Nigerian public officials’ penchant for foreign medical care is both a symptom and a cause of the country’s healthcare woes. It signals to the public that those in power do not trust the system, and it drains resources and political will that could otherwise be used to upgrade domestic facilities.
Read also: In life and in death Nigerian leaders are expensive, plus Ganduje’s curious transmutation
Below are key recommendations for Healthcare Reform to improve local services and discourage Medical Tourism by officials:
1. Invest in Quality, ‘World-Class’ Hospitals at Home: Nigeria should urgently upgrade a few of its best existing public hospitals to functioning centers of excellence who earn the distinction based on objective criteria, including Accreditation for Quality. The roadmap to this involves equipping the hospitals with cutting edge and appropriate equipment (MRI machines, radiotherapy, cardiac cath labs, etc.), hiring appropriate specialists to man them, and focussing on standardising processes and procedures through intentional and mandatory Quality Improvement. The current move to create enabling legislation for the formation of a National Health Facility Regulatory Agency (on the model of HEFAMAA in Lagos) as well as a deliberate push for Quality Accreditation in public and private facilities in some parts of the country should be given added official impetus.
Every State must be encouraged to have a Regulatory Agency that registers and sets Minimum Standards for its healthcare facilities – whether public or private. Private sector involvement in direct healthcare provision is a mandatory part of the roadmap to future development in Nigerian health. For example, the newly launched African Medical Centre of Excellence (AMCE) in Abuja, built in collaboration with Afreximbank and King’s College London, is a positive step. Such facilities can offer the most advanced treatments (for cancer, heart disease, etc.) that Nigerians used to go abroad for. The goal is to make it feasible, and desirable, for leaders and affluent Nigerians to get the best care possible anywhere without leaving the country.
Access for the less affluent and the general public should be facilitated through mandatory Health Insurance. Patronage of this facility, or any of a growing number of internationally accredited private facilities which already meet the highest universal professional and outcome standards, by the nation’s leaders will set an appropriate example. It would also make it safe eventually to impose an enforcible ban on the use of government resources by public officials to seek foreign medical care.
2. Improve Funding and Management of Public Hospitals: The government must increase the health budget, which is far below the level of 15% of total budget recommended by the WHO, and ensure its transparent and efficient utilisation.
Instituting performance audits, community oversight boards, and even privatization of hospital management where appropriate could improve efficiency of health facilities across the nation.
As a confidence-building measure, the Presidency should appropriately equip the State House Medical Centre to function as a VIP-level Primary Care facility, with additional capabilities for Resuscitation and Evacuation, and with an efficient referral handshake with one or more of the excellent multispecialty Quality hospitals already in existence in the nation for the provision of the highest level specialist care to the nation’s leaders on demand. A Presidential Suite may even be retained in any of the internationally accredited healthcare facilities located close to the seat of government for Emergencies that may required soecialised custodial care.
3. Tackle Brain Drain and Incentivise Doctors to Stay (or Return): With half its doctors abroad, Nigeria must incentivise medical talent to practice at home. This involves creatively arranging to pay enhanced salaries and allowances, especially to people with specialist, in-demand skills, and generally improving working conditions for health workers to reduce the push factors for emigration. Offering opportunities for career development, research opportunities, and providing personal and work-place security would help to retain highly skilled staff in the system.
Additionally, the government should facilitate diaspora engagement, encouraging Nigerian specialist doctors abroad to periodically come home to teach or perform surgeries (through initiatives such as visiting professorships, and sponsored programs). Supporting such initiatives (through grants, fast-tracked issuance of practising licenses by MDCN) would bolster capacity. In the long run, Nigeria would have enough highly-trained specialists to make all citizens feel comfortable under their health facilities.
4. Mandate or Strongly Encourage Officials to Use Local Healthcare: To break the pullo of Medical Tourism abroad, Nigeria should institute a policy banning government-funded foreign medical trips for public officials, except in cases where it can be proved that expertise with comparable outcomes is not available in the country. Such a policy intention was announced by the Federal Government in 2016, but has not been enforced with any seriousness to date. It cannot be safely enforced until most of the other conditions outlined here are met.
5. Upgrade Emergency and Specialist Care Nationwide: Emergency Care is one of the most problematic areas in Nigerian Healthcare. Many foreign medical trips are undertaken in emergency circumstances (e.g., road traffic accident, heart attack). Establishing a reliable emergency medical service and designating and upgrading a network of ICU/trauma centers in each geopolitical zone would save lives and instill trust. If a Governor has a car accident, a quality trauma center close by should be able to stabilize and treat him, and actually present a better possibility of survival than evacuation abroad.
Communication in emergency situations and pre-hospital care remain great causes of poor outcome in Emergency Care in the country. The government can collaborate with specialist organizations to equip designated local centers with life support facilities, linked by easy-to-activate emergency transport systems, including evacuation helicopters.
A unified countrywide emergency alert system like the underutilised Lagos ‘112’ and ‘767’ that can be activated from any phone in Nigeria needs to be put in place urgently.
An audit of Quality and Capability of existing healthcare facilities needs to be carried out in order to determine the spread of the different specialised competencies, and identify gap areas that need to be urgently addressed. Having in the country at least one ultra-specialized center for each major disease category (cancer, heart, kidney transplant, etc.) is crucial. Nigeria has started this with projects like the Nigeria Sovereign Investment Authority’s Cancer Center (Medserve-LUTH Cancer Centre), a concept that is in the process of being extended to other regions of the country.
6. Strengthen Primary Healthcare & Preventive Measures: Ultimately, the best way to reduce Medical Tourism is to have a healthier population (including leaders) who require fewer critical interventions. Nigeria should strengthen primary healthcare and preventive care, through measures that include routine screenings, vaccinations, health education. If lifestyle diseases like hypertension and diabetes are identified and managed early, they would reduce the need for foreign trips to treat complications later. Public officials should lead by example by subjecting themselves to Routine Health Checks in local facilities, which would also improve those facilities’ prestige and standards.
7. Public-Private Partnership and Expansion of Health Insurance: Government alone cannot fix everything in Healthcare. Encouraging more private sector investment in healthcare infrastructure is key – through tax incentives for building hospitals, subsidies for importing medical equipment, and public-private management models that have worked in other countries. Additionally developing the political will and mechanism to enforce mandatory health insurance (already mandated through the National Health Insurance Authority) will pool together huge resources to fund better access to good care for all Nigerians, reducing the burden on a few public hospitals, and eventually ensuring the long-desired Universal Health Coverage (UHC). When quality rises across the board, public officials will naturally feel safer getting care locally alongside their constituents.
8. Foster a Culture of Confidence and Ethical Leadership: Finally, there needs to be a cultural shift. Nigerian leaders must embrace, advertise and celebrate the ethos that “my health will be taken care of in the same system as my people”.
This may require both moral suasion and pressure from civil society. Media and citizens should hold leaders accountable – every time a politician goes abroad for care, relevant questions should be asked of them, such as: ‘Why?’ ‘What is lacking here?’ ‘How can we fix it?’
In conclusion, reversing the trend of Medical Tourism among Nigerian public officials is both symbolic and substantive. Symbolically, it will restore citizens’ faith if they see their leaders trusting the same clinics they use. Substantively, it will save Nigeria enormous foreign exchange currently spent on treatments abroad (estimated at $1–2 billion annually for Nigerians as a whole) and make it possible for the nation to reinvest such scarce foreign exchange into local health development.
The journey will not be overnight. It will require sustained investment, reform, and leadership commitment. The COVID-19 crisis of 2020 forced a momentary reckoning, when VIPs had to reconcile themselves to the fact that their lives would be in the hands of the same healthcare system whose deficiencies regular Nigerian knew all too well. That lesson should not be lost. Nigeria has the resources and talent -indeed, many of the world’s best doctors are Nigerians, With the right political will, it can build a healthcare system where no Nigerian – President or Peasant – will need to fly 5,000 miles for top-notch treatment.
Implementing the above recommendations would be a significant stride toward that goal.
Trust, as stated earlier, is a tough psychological entity, which cannot be enforced. But it can be fostered and reinforced by objectively creating measurable quality and availability in all the different specialties in our healthcare system, as well as ensuring they are accessible to everyone, including the leaders and drivers of the system.
It can be done, and it is the way to go.
Njide Ndili, President, Healthcare Federation of Nigeria (HFN) and Femi Olugbile, Writer & Health Administrator
