Lessons to Be Learnt from Turkish Healthcare

While Nigeria and Turkey had the same poor healthcare facilities decades ago, the deliberate decision by the Turkish government to raise its health sector budgetary allocation to 15 per cent and investment to over $30 billion, made a remarkable difference in that country. Martins Ifijeh who just returned from Turkey, reports

President of Turkey, Erdogan

Ever imagined why Nigeria’s healthcare system seems not to improve year-in-year-out despite the continued outcry for a better healthcare by the citizens, and the belief that the country has all resources needed to put it at par with that of other countries like the United States, Germany, India or Turkey?

Wonder no further. Nigeria has refused to do what these countries did to become healthcare destinations for not just their citizens, but for people of other countries and races, including Nigerians, even though it has what it takes. Others invest hugely in healthcare. Nigeria considers it one of the least sectors to spend money on.

Consider this! Nigeria hosted member countries of the African Union in 2001 where an Abuja Declaration was agreed and signed. Participating countries agreed that 15 per cent of their annual national budget will now be allocated to health. But till date the country which hosted the declaration, Nigeria, gives an average of 4.5 per cent allocation to health.

But the same attitude cannot be said of Turkey, which decades ago was struggling with its healthcare system just like Nigeria. But the deliberate attempt of its government to revamp the system through policies and investments have made it one of the best places on earth to access healthcare, especially in oncology, organ transplant, invitro fertilisation, orthopedics, among others; leaving Nigeria behind to continue to grapple with one of the poorest healthcare indices in the world.

For instance, while the Nigerian government said it was making efforts to revamp the healthcare system, it surprisingly allocated 4.17 per cent of the annual budget to healthcare in 2017, which is about N304 billion (less than $1 billion) for 180 million persons. Meaning the government will spend about N1,688 ($5.5) for a whole year on each citizen; an obviously unrealistic amount needed to treat a single episode of malaria not to talk of the entire health needs of a citizen for a whole year.

Maybe a clue should be taken from its sister country, Turkey, (sister because they were in the same healthcare situation decades ago), who has made successes within the last 20 years in the health sector.

This year, according to the Founding Chairman, Turkish Healthcare Travel Council (THTC), Emin Cakmak, Turkey’s health allocation from the 2017 annual budget is 15 per cent, which is about $6 billion to take care of the healthcare needs of about 80 million persons.

He said the health allocation was deliberate because the government had identified health as a major tool that can drive other sectors, adding that from the 100 per cent annual national budget, the government gives 30 per cent to health and education (15 per cent each), while other sectors, including security, economy, foreign affairs, transportation, among others, all share the remaining 70 per cent.

“For us to be where we are now, Turkish government invested $30 billion within the last 10 years into the health sector. We also make sure 15 per cent goes to the health sector from the annual budget. This, we have done over the years in order to be where we are now. The plan is to spend another $10 billion on the sector within the next five years,” he said.

Wondering if the investment made since two decade ago paid off? Indices show it indeed paid off. The country is now a medical destination hub to over 100 countries and 750,000 foreign patients yearly, while the citizens now feel at home when accessing healthcare. They now can conveniently treat ailments which take Nigerians to countries like India, U.S., UK or Germany.

On specifics, the once-upon-a-time poor healthcare country in almost all tertiary care, now has about the best facilities in oncology, orthopedics and trauma, ophthalmology, paediatrics and gynaecology, IVF, organ transplantation, dentistry, plastic surgery, genetics, among others.

In oncology for example, the gaps between Nigeria and Turkey calls for concern. Nigeria has seven radiotherapy machines for 180 million people, and specifically for the over two million cancer patients in the country.

However, information show that only two of those machines work at a time for many years now, meaning only two cancer machines work at a time in the country for the two million persons who need them. Health experts have continuously called for more and new cancer machines in Nigeria as the few ones are old and breaks down at will; a situation that has caused the death of many Nigerians, who ordinarily could have been treated using cancer machines if they were available.

But in Turkey, for its 80 million citizens, there exist 186 radiotherapy machines. Mr. Cakmak, while speaking with THISDAY in the just concluded Hestourex 2017 Congress and Exhibition in Antalya, Turkey recently, says majority of its 186 cancer machines are Truebeam. Truebeam is the latest radiotherapy technology/machine for cancer treatment.

For failing to invest in its healthcare and allocate reasonable percentage to the health sector, not only that Nigeria does not have a single Truebeam, it is using worn out and expired seven radiotherapy machines that break down at will because they have long past their lifespan.

This means for every cancer patient requiring radiotherapy, even if they love their country so much, Turkey will still be the destination. Nigerian government says it was putting efforts to stop medical tourism, but sadly, it was indirectly encouraging it by refusing to fix the system. A Nigerian suffering from cancer would rather go to Turkey for radiotherapy than wait in line for months to access possibly the only radiotherapy machine in Nigeria.

Decades ago, Turkey used to have dearth of doctors like Nigeria, but same cannot be said now as those who studied or resided in the U.S. or UK are returning back to become part of the healthcare revolution in their country. They have seen how investment in healthcare has changed the system.

For its 80 million citizens, the country has over 80,000 medical doctors and hundreds of thousands of nurses, pharmacists, physiotherapists, among others.

But Nigeria, which was in same condition decades ago is still having dearth of doctors. According to a Professor of the College of Medicine, University of Lagos, Folasade Ogunsola, in 2015, Nigeria has about 35,000 doctors, whereas it needs 235,000 medical doctors for its population in order to meet the World Health Organisation (WHO) recommendation of one doctor per 600 citizens. If Prof. Ogunsola’s figures are still relevant in 2017, it means Nigeria has one doctor to over 5,000 citizens.

Experts believed the two key reasons why doctors leave the country are poor renumeration and lack of standard healthcare environment to practise adequately. Nigerian doctors are said to flourish elsewhere. The U.S. has over 25,000 Nigerian doctors, according to records.

“We have now decided to make our healthcare provision open to the world, as we presently have what it takes to be the number one medical destination hub in the world,” says Cakmak, who is obviously glad the deliberate investments in their health sector has paid off.

“In terms of quality, we can only be compared to Germany and U.S., yet it is relatively cheaper to access healthcare here with same quality.”

Asked if same approaches could help the Nigerian health system, Cakmak said investment in healthcare definitely pays off on the long run, adding that on their part, they have at different times organised trainings for Nigerian doctors, and was willing to bridge the huge gap through the provision of healthcare to Nigerians who require certain types of treatment.

“Nigeria and Turkey quite have a good relationship. In oncology, we are ready to build bridges. If there are little or no radiotherapy machines in the country, patients who need treatment are welcomed into our country to access it,” he said.

He said apart from oncology, treatments on dentistry, ophthalmology, organ transplantation, paediatrics and gynaecology, genetics, IVF, orthopedics and trauma, among others are offered in Turkey for those who need them, whether its citizens or foreigners like Nigerians.

The advancement of its healthcare provided room for the establishment of the Turkish Healthcare Travel Council to strengthen tourism activities and unite the national efforts to bring more patients to the country from around the world.

“With 317 members, consisting of hospitals, clinics, thermal and medical SPA centres, hotels, assistant companies, and with 144 network offices in 85 different countries, the council has grown into the largest healthcare association both in Turkey and the world,” says Cakmak, who believes the country was now ready and willing to extend its healthcare services to the world.

But how has the THTC benefitted Nigerians? The Director of Nigeria THTC, Dr. Adedayo Sobamowo says the council has over the past four years provided medical consultation and facilitation services to enable over 300 Nigerian residents receive world class medical treatment in Turkey, adding that these treatments have included brain and spinal surgery; IVF treatment; cancer diagnosis and treatment; comprehensive medical check ups, medical spa and detoxification; weight loss surgery; knee and hip replacements; cardiac surgery; renal surgery and a host of other highly specialised medical procedures.

While Nigeria is striving to curb medical tourism, the clear lack of investment in the sector has made it somewhat inevitable, especially on issues requiring certain expertise and facilities which the country lacks. Their former partner-in-struggle, Turkey, is now well positioned to offer help in this regards for Nigerian patients requiring medical treatment abroad.

This shows a tale of two nations. Same challenges and wishes, but with different approaches and zeal. In the end, one is better placed to save the world, while the other is probably comfortable being saved by the world.