African leaders and the penchant for medical exodus

The recent death of Nigeria’s former President Muhammadu Buhari in a London hospital has reignited a painful spotlight on Africa’s leadership paradox. While its rulers routinely seek world-class medical care abroad—often at staggering public expense—they preside over crumbling healthcare systems that fail their citizens. This enduring scandal goes beyond mere hypocrisy; it represents a fundamental crisis of dignity that undermines Africa’s self-respect and global standing.

The historical pattern is damning. From Gabon’s Léon M’ba (1967) to Ethiopia’s Meles Zenawi (2012), generations of African leaders have spent their final moments in foreign hospitals. Nigeria’s Umaru Yar’Adua’s prolonged medical absence and subsequent death after returning home became emblematic of this systemic failure. These cases reveal a tragic irony: leaders who control national resources consistently choose foreign systems over developing comparable facilities at home.

Nigeria’s State House Clinic debacle exemplifies this betrayal. Despite receiving ₦15.24 billion (about $9.95 million) between 2015 and 2023, the presidential facility lacked basic supplies—a fact publicly acknowledged by former First Lady Aisha Buhari. Meanwhile, national health spending remained below 6.5% of the budget, far short of the Abuja Declaration’s 15% target. The doctor-patient ratio collapsed from 1:4,000 to 1:9,000 as medical professionals fled abroad, a direct consequence of failed policies under Buhari’s health ministers, all of whom antagonised Nigeria’s doctors at one point or another.

This medical exodus carries profound psychological consequences. How can a continent demand global respect when its own rulers don’t trust their healthcare systems? Every presidential evacuation reinforces the narrative that Africa cannot care for its own—not even its most privileged citizens. As Buhari’s spokesman, Femi Adesina, admitted, the former president sought foreign care because “staying alive came first”, a statement that inadvertently condemned Nigeria’s healthcare system. This crisis of confidence becomes self-perpetuating: the more leaders seek foreign treatment, the less they invest domestically, and the more the world views Africa as perpetually backwards.

President Bola Tinubu’s suspicious “working holidays” in France and Paul Biya’s Swiss medical excursions continue this humiliating tradition. Their actions implicitly declare that African lives—including their own—are worth less than those in the West. When leaders won’t use their own hospitals, why should foreign investors, tourists, or even citizens believe in African institutions?

Breaking this cycle requires courageous leadership. Malaysia’s Mahathir Mohamad famously banned overseas treatment for officials, forcing domestic healthcare improvements. Rwanda’s Paul Kagame has invested heavily in medical infrastructure, creating regional centres of excellence. These models prove dignity comes from self-reliance, not medical passports.

As long as African leaders prioritise foreign treatment over domestic development, the continent will struggle for genuine self-respect or global esteem. True sovereignty begins when presidents entrust their health to African hospitals. Until then, the tragic irony of leaders dying abroad will remain a damning indictment of unfulfilled promises—and a stark reminder that the world will only respect Africa when Africa respects itself.

Nwanze is a partner at SBM Intelligence