Choosing where to seek medical help is a deeply private decision. But the numerous occasions African leaders have sought treatment abroad have thrown the spotlight on local health care investment. To a large extent, leaders are responsible for the development of proper health care for the citizens of their countries.

The deaths of former leaders Muhammadu Buhariof Nigeria and Edgar Lungu of Zambia in foreign medical facilities have not calmed accusations that African leaders neglect public health systems in their own countries. 

"The state of health care in Nigeria is deeply concerning. The biggest problem is infrastructure. There are no drugs and functional medical equipment," Jamila Atiku, a researcher on public health in Nigeria, told DW.

Low investment in public health

Reasons for medical tourism include a lack of specialized treatment available locally, poorly equipped hospitals and security fears for politicians.

Another factor, according to Zimbabwean health rights advocate Chamunorwa Mashoko, is an over-reliance on foreign aid.

"Among African countries, over 32 out of 54 countries are not allocating significant budgets to health. This is motivated by overdependency on donor aid," he told DW.

"Africa is failing to realize that foreign funding in health is just for diplomacy. Those assisting us with all that aid really has nothing to do with our health challenges," Mashoko added. 

African countries receive more than $60 billion (€52 billion) in health funding, representing just a fraction of the total health financing needed for the continent.

Under the 2001 Abuja Declaration, African Union (AU) member states committed to end the continent's health financing crisis by pledging to allocate 15% of their annual national budgets to health care.

But over two decades later, only three countries, Rwanda, Botswana, and Cape Verde, have consistently met or exceeded the target.

The World Health Organization (WHO) reports that over 30 AU member states allocate less than 10% of their budget to health care, with some allocating as little as 5-7%.

"Nigeria has been fluctuating between 4-6% of the annual budget," said Atiku, adding that politicians are only concerned about other infrastructure development projects like roads. 

"Doctors and health care professionals are always going on strike because they are underpaid."

Inadequate public financing of health has resulted in poorly run, underperforming health systems across many African countries. 

"Over-reliance on external funding is highly unsustainable and inconsistent with achieving Universal Health Coverage," said Itai Rusike, of the Zimbabwe-based Community Working Group on Health.

"The Abuja target of 15% allocation to health has remained an elusive target. It is now outdated given the population increase, huge disease burden and the levels of neglect of infrastructure and health worker retention," Rusike added.

Which medical services are sought abroad

A chronic lack of specialized treatment and facilities is driving many African patients to seek medical treatment abroad. The sectors affected include oncology, cardiology, neurology, orthopedics, organ transplants, fertility, and pediatrics for the management of rare genetic disorders.

Over 300,000 Africans travel to India annually for medical services, spending more than $2 billion each year.

India is said to be generating more than $6 billion each year from medical tourism. 

Projections show the Asian country could get $13 billion in medical tourism by 2026 under the "Heal in India" initiative.

According to the African Journal of Hospitality, Tourism and Leisure, Nigerians are estimated to spend $1 billion annually on medical tourism. 60% of that amount is spent on oncology, orthopedics, nephrology, and cardiology. Additionally, the figure represents almost 20% of the annual public health expenditure that covers the salaries of health workers.

An estimated 5,000 Nigerians fly out of the country monthly for medical treatment, many traveling to India.

What needs to be done

Some African health authorities argue they are doing their best to improve healthcare for their countries.

"There is room for improvement to fund the health sector. We are targeting to ensure by 2027 at least 17,000 primary health care facilities are functional in Nigeria," Nigeria's Minister of State for Health and Social Welfare, Iziaq Adekunle Salako, told DW.

"There is not a health system in the world that is 100%. We believe we are headed in the right direction in implementing solutions."

Health experts say African governments need to build modern health facilities to offer services currently being outsourced abroad.

"Looking up to politicians will not work. Communities need to come together and pull resources to create health care systems that work for them," health rights advocate Chamunorwa Mashoko told DW. 

In 2016, the continental lender Afreximbank launched a support facility to build specialized health facilities across Africa to reduce outbound medical tourism.

The initial target would focus on establishing a center of excellence for cancer patients. Tanzania, Nigeria, Kenya and Ghana were identified as suitable to host the facilities.

Edited by: Cai Nebe