Remember that time government claimed there was “reverse medical tourism”?, By Chinedu Moghalu

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Perhaps then, Nigeria’s talk of reverse medical tourism should not be read as self-congratulation but as a glimpse of a shifting map. Competence and confidence are no longer monopolies of wealthier nations. The future of healthcare will hinge less on where technology sits and more on where trust can be found, on which systems can deliver timely, affordable, and humane care when people need it most. For some, that place is now closer to home, for others it remains abroad.

Recently, a US physician named Pamela Buchanan MD wrote on LinkedIn with startling candour. She spoke not of privilege but of pain. “We are walking away,” she wrote, “not from medicine, but from a system that breaks us.” Her post described colleagues who had abandoned their calling, sold their clinics, or switched careers altogether. One now runs a restaurant, another a gym, she bemoaned. They were not defeated by science but by a system in which care has become a contest between exhaustion and expense. The moral injury is shared by patients who cannot see a doctor and by professionals who can no longer bear to try.

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Upon reading her post, I reached out to a few family members and friends in medical and pharmaceutical practice outside the country. They said she was actually careful in her narrative, and that reality in many places is even harsher. A comment under Dr Buchanan’s post by Nelson Arriaza-Silva, a Health Care Professional, extended the narrative: “As a Healthcare Administrator with over 25 years of experience in both for-profit and non-profit healthcare organizations, I strongly echo Dr. Buchanan’s concerns. Too often, upper-level leadership prioritizes maximizing profits by pressuring medical providers to deliver more with less, rather than supporting the people who are at the heart of patient care….” Then I recalled the uproar that erupted in our media space in February when Nigeria’s Coordinating Minister of Health, Professor Muhammad Ali Pate, remarked that some people from the United Kingdom and the United States were now coming to Nigeria for treatment, a claim later echoed by Vice President Kashim Shettima. Many dismissed it as improbable and baselessly political. Yet, if we step away from outrage and look closely at the state of healthcare worldwide, the claim is less absurd than it first sounded.

In the United Kingdom, the National Health Service is burdened with more than seven million outstanding treatment pathways; and in the United States, the Merritt Hawkins 2024 Survey found that the average wait for a doctor’s appointment in major cities has stretched beyond a month, while the cost of routine diagnostics often rivals some family’s monthly earnings. Kaiser Family Foundation data shows that roughly 100 million Americans carry medical debt. What these numbers mean for ordinary people is simple. Appointments arrive too late, bills arrive too high, and conditions that could have been managed early become emergencies. Access and affordability are collapsing in systems once held up as models.

These pressures explain why a growing number of Diaspora Nigerians, and some foreigners, now schedule procedures in Lagos or Abuja or Port Harcourt, rather than London or Houston. At Zenith Medical and Kidney Centre in Abuja, surgeons perform roughly a dozen kidney transplants every month, totaling over 800 successful transplants since 2019. St Nicholas Hospital in Lagos, now a regional training hub for West Africa, has surpassed its five hundredth case and there are many more. The newly opened African Medical Centre of Excellence, backed by Afreximbank, is positioning Nigeria to compete in oncology, cardiology, and diagnostics. The meaning for patients is practical. A predictable date for surgery, a bill that can be planned for, and specialist teams that have now done these procedures at scale are powerful reasons to stay home or to come home.

Between late 2023 and mid 2025, more than 3.2 million Nigerians were newly enrolled in health insurance, bringing total coverage to about twenty million people, most of them through social schemes. These are not statistics for reports. They are the difference between postponing care and walking into a facility with a defined benefit that can actually be used.

Still, the larger truth remains sobering. Nigeria continues to lose over a billion dollars a year to outbound medical travel. For every patient who flies in, many more still fly out. Yet, beneath the imbalance lies a system in transition. The Nigeria Health Sector Renewal Investment Initiative, launched from the Presidency in December 2023, has begun to bring order to decades of fragmentation. All states and development partners have signed onto a single Compact built around one plan, one budget, one report and one conversation, which means funding and effort now meet at the same table, rather than pulling in competing directions. Health insurance, made mandatory by the National Health Insurance Authority Act 2022, has moved from aspiration to enforcement. In September, the Presidency directed federal ministries, departments, and agencies to enrol their employees and to link procurement, licensing, and regulatory approvals to proof of coverage, with real time digital checks. As such, compliance is not on paper but in practice. For workers, this means a card in hand, rather than cash at the gate. For employers and providers, it means predictable pools and payment.

Between late 2023 and mid 2025, more than 3.2 million Nigerians were newly enrolled in health insurance, bringing total coverage to about twenty million people, most of them through social schemes. These are not statistics for reports. They are the difference between postponing care and walking into a facility with a defined benefit that can actually be used. The Basic Health Care Provision Fund 2.0 now channels resources directly to primary health centres, subsidising coverage for the poor and vulnerable, which means the first point of contact in the community is financed to function. Nearly ₦90 billion has been sent straight to over eight thousand facilities, more than one thousand, three hundred have been fully revitalised and about five thousand more are underway. In the first quarter of 2025, thirty-seven million Nigerians sought care at primary health centres, in comparison to ten million a year earlier. The meaning is clear. People are choosing nearby clinics again, small problems are getting treated before they become crises, and pressure on tertiary hospitals are beginning to ease.

The 2023 federal health budget rose by more than forty per cent to ₦1.17 trillion, matched by an ambitious vaccination drive targeting over one hundred million children. In 2024, it was increased further by 5.5 per cent of the total expenditure, while this year it is about six per cent of the total spending — the highest in over a decade. Claims data from rural providers now feed into digital dashboards that track quality, timeliness, and use, which allows managers to fix bottlenecks with evidence, rather than guesswork. Specialty capacity is also moving. Three new oncology centres have opened in Katsina, Enugu, and Benin, with three more planned, and the Presidential Initiative for Unlocking the Healthcare Value Chain has mobilised more than $5 billion in investments, including support from Afreximbank and the European Investment Bank. For Nigerians, this translates to shorter waits for biopsies and radiotherapy, more reliable imaging, and hospitals that can upgrade without spending months trapped in customs and currency shocks.

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These efforts have not erased shortages, but they are visible in daily life. Federal workers now receive insurance cards at the onboarding stage, which changes the conversation at the clinic desk from payment first to eligibility and care. Trade groups are negotiating group plans, so that market women, artisans, and drivers are not priced out of care at the point of service. NHIA tariffs have been recalculated using actuarial evidence, with capitation rates up ninety-three per cent and fee-for-service payments up three hundred and eighty per cent. For facilities, this means salaries and supplies can be planned, stockouts become less frequent, and providers have a reason to improve patient experience. Out-of-pocket spending still sits above seventy per cent of health expenditure, but the direction of travel is toward pooled purchasing, rather than cash payments that push families into debt.

Until nations, rich and poor alike, make health a guarantee rather than a gamble, the queues will lengthen, the weary will walk away, and the miracle of medicine will remain incomplete. In the end the question returns to its simplest form, asked quietly in houses and waiting rooms on every continent: Where can I find a doctor?

Nigeria’s doctors, like their peers abroad, are weary. Of about one hundred and thirty thousand ever registered, fewer than sixty thousand were active by 2023. The government has responded with a Health Workforce Migration Policy and a National Health Fellows Programme that places young professionals across seven hundred and seventy-four local governments. The intent is straightforward. Communities that have long waited for a clinician are meant to see one more regularly, and hospitals that trained talent for export are meant to retain more of it. Yet, even physicians who have migrated acknowledge that the systems they joined are themselves faltering under bureaucracy and burnout. What unites both experiences is not geography but exhaustion. It is the cost of caring in systems that reward throughput more than relationships.

Perhaps then, Nigeria’s talk of reverse medical tourism should not be read as self-congratulation but as a glimpse of a shifting map. Competence and confidence are no longer monopolies of wealthier nations. The future of healthcare will hinge less on where technology sits and more on where trust can be found, on which systems can deliver timely, affordable, and humane care when people need it most. For some, that place is now closer to home, for others it remains abroad. What matters is that the boundaries of credibility are moving.

The physician who cannot prescribe an affordable drug and the patient who cannot afford to see her inhabit the same crisis of access. Until nations, rich and poor alike, make health a guarantee rather than a gamble, the queues will lengthen, the weary will walk away, and the miracle of medicine will remain incomplete. In the end the question returns to its simplest form, asked quietly in houses and waiting rooms on every continent: Where can I find a doctor?

Chinedu Moghalu, is a lawyer, strategic communications expert, and public policy adviser with over two decades of leadership across government, international organisations, and development institutions. Currently, senior special adviser to Nigeria’s Coordinating Minister of Health and Social Welfare.