•Global Comparison: How World leaders approach healthcare

By Njide Ndili and Femi Olugbile

A few days ago, Nigerians received the sad news of the death of its former President, Muhammadu 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 looks 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.

Long History

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. 

  Global Comparison

 Around the world, a leader’s choice of healthcare often reflects the strength of their country’s medical system and their confidence in it, their consciousness of the importance of perception concerning their choices, as well their consciousness of the national security implications attached.

United States (Presidents)

 U.S. presidents universally use American hospitals

The White House has its own medical unit and access to top hospitals (e.g. Walter Reed Medical Center). When President Donald Trump contracted COVID-19 in 2020, he was treated at Walter Reed in Bethesda, MD. The U.S. health system’s advanced capabilities and security protocols make domestic care the default. It would be politically unthinkable for a U.S. president to go abroad for medicaltreatment.

 United Kingdom (Prime Ministers)

UK leaders trust local care, often in NHS hospitals

Example: In 2020 PM Boris Johnson, ill with COVID-19, was hospitalized at St. Thomas’ Hospital in London and even spent time in ICU. He publicly thanked the NHS doctors “who saved my life,” boosting confidence in the national system. The UK’s NHS, despite challenges, is world-class in critical and general care, so there is no incentive for leaders to go abroad.

 India (Prime Ministers)

Indian leaders use top Indian hospitals (with occasional foreign care in past decades)

India has centers of excellence like AIIMS in New Delhi.  PM Manmohan Singh underwent a complex heart bypass surgery at AIIMS in 2009 while in office. (He had earlier heart surgeries abroad as a private citizen, but as PM he showed confidence in local expertise.) The robust Indian private healthcare sector and national pride encourage domestic treatment.

South Africa (Presidents)

South African presidents and top officials are generally treated at home

South Africa’s hospitals (public and private) are among Africa’s best. Nelson Mandela, for example, received his final treatment for a lung infection at a Pretoria hospital in 2013, surrounded by South African doctors. The country’s capability in specialty care (e.g. heart transplants pioneered locally) instills trust. Traveling abroad is unnecessary and politically discouraged.

 Tanzania (John Magufuli)

President Magufuli famously banned government officials from foreign medical trips and showcased local hospitals

In 2016, the President had his wife admitted to Muhimbili National Hospital (a public facility in Dar es Salaam) rather than flying her abroad. This was unprecedented in a region where First Families often use foreign hospitals. Magufuli’s stance was ideological and his policy was as much about austerity as quality.

 Zimbabwe (Robert Mugabe)

Reliant on foreign care due to President Mugabe’s personal preference and a weak local system

President Mugabe, despite official rhetoric  about a need for self-reliance, flew frequently to Singapore for medical check-ups . Zimbabwe’s once-strong health system decayed, partly because the nation’s President did not show confidence in it.

• Sources: Media reports and official statements . 

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 HealthOrganization 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. Significantly, 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. 

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. 

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 amandatory 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 Nigerianeeds 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.

• Ndili, President, Healthcare Federation of Nigeria (HFN), and Olugbile,  Health Administrator, write from Lagos