An air ambulance to India


A friend of mine travelled from Lagos to New Delhi for a business meeting, and called me shortly after his return. “Chikwe, you will not believe what I experienced on the flight; almost every passenger had a tube of some sort, from catheters to intravenous lines, often accompanied by nurses or/and family, both in business class and economy class, all headed to India for healthcare that they cannot get in Nigeria”. He said it felt like being on an air ambulance. A Nigerian newspaper speculated that at  least 3,000 Nigerians travel each month for medical treatment to India, spending close to $200 million (N30 billion) yearly. While it is not clear where these figures come from, another newspaper is explicit in reporting that the Indian High Commission in Nigeria issued 4,000 medical visas to Nigerians seeking medical treatment in Indian hospitals in 2009. This is what has become of our once great country.

What started as a niche endeavour, often for serious conditions such as renal transplants has evolved into big business. As the years have progressed, more and more people are losing confidence in the services offered by our hospitals in Nigeria, and raise funds desperately to go to India for even minor ailments. Indian hospital services have risen to the challenge of the discerning Nigerian, who often come with his payment in cash and have access to a wide range of care, but also ancillary services including airport pickup, accommodation for the family, support with logistics in India and even phone cards to call home. All of this can easily be organised over the internet by companies specialising in “medical tourism”. But it does not end there, at the end of treatment, patient “testimonials” are put up on hospital websites as this one. There are even emerging “innovative” health insurance packages offering healthcare in India.

Not satisfied with the Nigerian patients coming to India, they are bringing Indian healthcare to Nigeria. The famous Apollo Hospital group recently announced plans to build a hospital in Nigeria. A modestly named Primus International Super Specialty Hospital has recently started providing health care services from Karu, in Abuja, and it appears that Nigerians have not wasted any time in making it their new favoured destination for health care in Abuja.

So why has the Nigerian healthcare industry not evolved and kept pace with the rest of the world. Like India, we have Nigerian doctors trained and are working in the best healthcare sectors in the world. Across the USA and the UK, Nigerian doctors have reached the very peak of their professions. We have a growing and discerning middle class. We had pioneers in the provision of private health care in groups like Eko Hospitals. We have huge banks with money to spare to finance projects in healthcare. Mckinsey in its important report in 2009 stated that:

The expected improvement in Africa’s macroeconomic climate over the next decade will expand the healthcare gap, as higher incomes will create new demand for quality.

So, while we are happy for the entrance of India into the Nigerian health scene, at least for the sake of those that are not able to travel, we really need to see some of the innovation that has driven the growth of the telecommunications industry, the financial services industry brought to bear in the health sector. The truth is that such innovation will not necessarily come from doctors, infact it is unlikely to!  For growth to happen, we need innovation in financing models, management models as well as the core medical expertise. No country’s health sector has grown with a fee-for-service structure as is presently pervasive in Nigeria.

I truly believe that the health sector is the next big thing…..but it will depend not on the money we throw at it, but on our ability to combine our intellectual capital to find a workable solution for Nigerians. Because of the pace of development around the world, this will have to come both from expertise in Nigeria and in the Diaspora.

Nigerians can do this….! If not for our health, for the money. While investing in the Indian economy is great, investing in the Nigerian economy is even greater, and maybe we can save a few lives in the process.

In my life time, I hope we will see people travelling to Nigeria for their health care – as one of my mentors says – we have to set BIG BOLD and AUDACIOUS goals for ourselves – this is one! 

Lets go do….

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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