Beware the hand that serves what it will not taste: Presidential medical tourism and implications for healthcare development (2015–2025)

Abstract

Persistent presidential medical tourism in Nigeria between 2015 and 2025 exposes a growing disconnect between elite health-seeking behaviour and the condition of the national health system. This study investigates how successive presidents, despite making ambitious commitments to reform, continued to seek medical treatment abroad, thereby weakening public trust and the credibility of health governance. Guided by the Theory of institutional distrust, the study argues that when leaders avoid the public services they provide, they reinforce citizens' perceptions of institutional failure and diminished accountability. The study employs a qualitative approach based on documentary analysis, policy reviews, media sources, and secondary literature. The results show that, although various reforms, such as increased funding, infrastructural upgrades, and international collaboration, were introduced, health outcomes remained poor. Both presidents made repeated overseas medical visits, indicating a lack of confidence in domestic facilities. Their behaviour contributed to the failure of symbolic leadership, public distrust, economic losses, the departure of medical professionals, and policy inconsistency. The discussion highlights that this contradiction between rhetoric and conduct fuels a cycle of institutional distrust. The conclusion emphasises that genuine health sector reform requires leaders to use and improve local facilities, which is essential for rebuilding trust and achieving sustainable development.