It appears there is a surge in medical tourism bound for the far-east. Malawians that can afford medical care are opting to go to foreign countries. Our hospitals are lacking basic equipment and we all are scrambling for that forex in the banks. India has now become the main destination for people seeking medical attention. Traditionally, medical tourists have opted to go to South Africa and, in some instances, the UK. Medical tourism has now become a big industry that rakes billions of dollars in countries such as India. To put in simple terms, Malawi is a net importer of medical services. We will continue doing so until we make some interventions that will equip our doctors with the right tools. Unfortunately, it is only a few elites who can afford foreign medical care. The average person is doomed.
Efficient health system
A health system that is efficient and cost-effective is what Malawi needs. An average person still relies on government for referrals beyond the border. It is a painful process and not an easy one except for the connected few. The implications are disastrous. People become less productive and extend the social burden during illnesses and eventual death. The situation is even complicated if they are private sector employees, self-employed or peasant farmers. Most of such folks cannot afford private health insurance to seek medical attention overseas. We are experiencing a lot of productivity gains at various levels. Probably it is worse among the poorest of our society due to illness. Our GDP is predominantly subsistence based anyway. No one doubts the abilities of our doctors, but the system has inadequate equipment to make their practice effective.
The first lot of doctors from University of Malawi (Unima) graduated in the late 1990â€™s. Before that, we used to train them in foreign countries such as Australia and the UK. It was a good investment and worthy any dollar from public coffers. Over the years, the medical school has grown and has even expanded programmes to meet the needs of our health system.
During the same time, a lot of our doctors have left the country to practise in other countries. A tale goes that the city of Manchester has more Malawian doctors than the entire public health system in the country. Our attempt to reduce the outward movement of doctors has been two fold.
Firstly, doctors were allowed to privately practise while working fulltime for government. Secondly, donors have pumped in money to supplement their salaries. We have ignored the fact that a doctor is more annoyed when patients die simply because some equipment is not available to do some life saving procedures. It is not always about the pay cheque. It now has become a trend that our well trained doctors have to simply examine patients and refer them to foreign countries.
Investing in medical infrastructure
We are heavily reliant on the public health system yet serious attempts have not been made to address some cardinal shortfalls of a 21st medical practice. It had to take a CCAM donation of a dialysis machine to one of the central hospitals. Tales of hospitals lacking surgical equipment are not uncommon. It is extremely difficult or dangerous to conduct an operation without anaesthetics or other surgical equipment.
At the same-time, we have borrowed heavily to build a hotel and a soccer stadium at the expense of a health system lacking in basic infrastructure. While the flamboyance and spectra of high rise buildings add beauty to our cities, it does not address our health needs. It does not stop us from referring patients to Garden City or somewhere in India nor does it arrest health professional brain drain.
In fact, our forex in the process is spent on overseas doctors and associated care services. Why not invest loaned money in world class medical facilities so that we can retain our doctors and ensure world class health care is available right in the country? This is a possible trade in health services for foreign nationals and benefits would also accrue to our citizens. We can simply retain our doctors by providing our hospitals with all the necessary facilities and equipment. It is not always the money that we pay them, but the ability to work effectively that counts sometimes.
Matters of international trade and medical tourism
Malawi traditionally trades more with South Africa and the Sadc region due to their proximity. However, the rise of China and India cannot be ignored. Most of pharmaceutical products in use in our hospitals are imported from India given its lower costing. India has become the main destination of medical tourism. There are a few things we can learn from them other than simply getting a $30 million credit line to pay for petrol. I believe our trade is unfavourable and we can reduce the deficit.
Specifically, we have now reached a situation whereby we are importing both medicines and services of foreign doctors. It is not about stopping people from seeking medical attention to countries of their choice, but providing cheaper world class alternatives at home. The medical school has been expanding, but we have not matched its aspirations by equipping our doctors with the necessary tools to effectively practise.
A pharmaceutical industry is difficult to establish, but equipping our hospitals with the right tools is no rocket science. While we have been training doctors to higher levels of specialisation, equipment does not exist for them to practise. We have now reduced most of them to recommending patients overseas, yet they have the skills except for the non-existent equipment. In the end, we can reduce the cost of health care by doing most of the procedures in the country and save ourselves some forex. Our colleagues in India have been crafty in developing their health system for business through various global networks with health insurance companies such as our own Medical Aid Society of Malawi (Masm). We may not do exactly the same, but we can equip our hospitals with the right equipment and tools. It would be cost effective and more efficient.