African leaders

By Hadiza Abdulkadir

The death of Nigeria’s former President Muhammadu Buhari in a London hospital has once again spotlighted the country’s long-standing crisis in healthcare delivery, especially among its elite. 

Buhari, 82, died on Saturday, July 13, after a prolonged illness reportedly linked to leukaemia. Despite leading Africa’s most populous nation and the continent’s largest economy, he died not on Nigerian soil, but under foreign care.

His passing mirrors a now-familiar pattern among Nigeria’s political class: fleeing abroad for treatment, even for routine ailments, only to eventually die in foreign hospitals. Buhari, who frequently sought medical attention in the United Kingdom during his presidency, had once campaigned on the promise of reducing medical tourism. Instead, he became one of its most prominent symbols.

Public reaction has been swift and critical. Muhammad Shakir Balogun, a resident advisor with the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), condemned the trend in a widely shared Facebook post. Drawing comparisons with African icons like Nelson Mandela and Jerry Rawlings—both of whom received treatment and died in their home countries—Balogun wrote:

“They were not flown to London, Paris, or Amsterdam. They were attended to in their own countries by their own doctors… What of Nigeria, the giant of Africa? Even those who campaigned on the moral pedestal of not going abroad for treatment turned out to be the worst offenders ever.”

He called on current President Bola Tinubu to “break the despicable and shameless tradition” by ensuring at least one world-class hospital exists within Nigeria—“even if it’s a military hospital.”

Yet, President Tinubu himself has also faced criticism for continuing the same tradition. Since assuming office in May 2023, he has reportedly travelled to Paris multiple times for medical checkups, reinforcing the perception that Nigerian leaders lack confidence in the very healthcare system they oversee.

Critics argue that the reliance on foreign healthcare is not just a failure of policy but a profound betrayal of public trust. Nigeria’s public hospitals suffer from underfunding, dilapidated infrastructure, and a mass exodus of medical professionals, many of whom now work in the very countries to which Nigerian leaders turn in times of illness.

With Buhari’s burial scheduled for today in his hometown of Daura, Katsina State, attention is turning not just to the legacy of his leadership, but to the urgent need for healthcare reform at home, so that future presidents may live, heal, and if necessary, die on Nigerian soil.

By Muhammad Muzdaleefa

Founding leaders of nations matter. A country’s founding moment is often a make-or-mar moment in the life of the country. The trajectory on which the founding leadership sets the country, as well the power of their founding example, often defines and determines the future course of events way past the founding generation. Founding precedents tend to have an exceptional degree of endurance, because founding leaders command a kind and degree of legitimacy and license that is exceptional and which gives them and their example and precedents a special status and the propelling force of path dependency in their country’s history.

George Washington’s founding example, of not offering himself up for election again after serving two terms as (first) president of the new republic, even though nothing in the US constitution at the time imposed term limits on an incumbent president, initiated a tradition of American presidents not going beyond two terms; a tradition that remained in place until Franklin Delano Roosevelt breached it in the 1930s/40s, causing it to be restored by constitutional amendment. Additionally, the contemporary trajectory of American federalism, including the enduring fault lines in its politics, can be traced back to the Federalist/anti-Federalist split in the founding generation; between the Hamiltonian (strong federal/center) and the Jeffersonian/Madisonian (strong states) visions.

The death of Lee Kuan Yew, the founder of modern Singapore and its prime minister from 1959 to 1990 (then senior minister after that), has brought the usual apologists of autocratic rule in Africa out of their holes, doing what they do best: making all manner of inapt comparisons and prophecies of “what would have been” had one or the other favorite African autocrat been allowed to rule for as long as Lee Kuan Yew did. There is the implicit suggestion that similar longevity in office would have turned Lee’s African contemporaries into a Lee Kuan Yew or transformed their African states from Third World to First. It is a fanciful thought, one not borne out by the record.

First of all, Africa’s first generation of autocrats did, in fact, stay in power for very long periods. Nyerere, Kaunda, Banda, Houphouet Biogny, Mobutu, Bongo, Senghor, all were in power continuously for nearly three decades. And many current ones, including Mugabe, Museveni, and Biya have equaled or broken the record. None has managed any transformation of the Lee Kuan Yew kind, except in the opposite direction. So, the difference between Lee Kuan Yew and his African contemporaries was not just a matter of longevity in power, it was far more than that. Time itself is a value-neutral resource. It is what you do with the time you have that determines the future course of events. Africa’s autocrats did very different things with their time in power than Lee Kuan Yew did with his. They were bound to reap different results.

Second, while Lee Kuan Yew was an authoritarian leader, he was not an autocrat. It is an important distinction. Lee built and worked through institutions. He did not destroy the rule of law. Lee’s government passed and enforced draconian laws, but arbitrary and personal rule did not displace government through institutions, rules, and procedures. Lee also assembled and worked with a solid team (the first group of which is featured in the book “Lee’s Lieutenants”). His was not a one-man project; he was captain of a team. Lee’s Lieutenants brought to the table a complement of talents and abilities that Lee, as leader, effectively harnessed and synthesised into a shared vision. There was no “Lee Kuan Yewism” to which all were obliged to swear allegiance or else. And while Lee Kuan Yew did not like or think much of his opposition, he never declared a one-party state. His party contested elections and won those elections repeatedly. The franchise was not aborted. Nor were opposition parties. Absence of electoral turnover is inconsistent with competitive parliamentary politics. The Liberal Party’s overwhelming hold on power in postwar Japan is a case in point.

Lee Kuan Yew ruled for as long as he did, in part because he did not replace Singapore’s Westminster parliamentary system with a presidential system. The title “President” apparently had no particular allure for the supremely self-confident Lee. He was happy to be a “mere” prime minister, which meant that, as long as his party continued to win a majority in parliamentary elections and he retained his own seat and leadership of the party, he was free to remain prime minister. Term limits have been traditionally associated with presidential systems, not parliamentary systems. Today, his party remains in power, even if its electoral strength has diminished over time.

Lee’s contemporaries in Africa, on the other hand, moved quickly to replace their parliamentary systems with presidential rule. It was one step on the road to autocracy. It freed them from accountability to their party, to cabinet, and to parliament. From that foundation, other blocks in the autocratic project fell into place.

There are many other ways in which Lee Kuan Yew and his African contemporaries were fundamentally different. They, like Lee, did not care much for human rights, free speech, free press, and the like. Lee Kuan Yew believed in “Asian values”, not “Western democracy”. And his African contemporaries too defended their own idiosyncratic versions of African exceptionalism. But that’s pretty much where the similarities end.

Instructively, Lee Kuan Yew recalls telling himself, after a 1964 visit to Africa that took him to 17 countries, “I was not optimistic about Africa”. Lee said. And while in Lagos in January 1966 for the Commonwealth Heads of State conference, Lee again recalls, after observing the Nigerian government at work: “I went to bed that night convinced that they were a different people playing to a different set of rules.”

Nothing is gained, except more of the same escapism and revisionism that keeps us stuck in the counter-developmental past, by trying to cast one or the other African autocrat in the mold of a Lee Kuan Yew. We have had no Lee Kuan Yews. Not that we need or must have one. But, well, just saying!