In recent years, the health sector in Nigeria has been marred by persistent industrial actions, causing significant disruptions to public health institutions and detrimentally affecting the well-being of the Nigerian population. The ongoing tug-of-war between healthcare workers, predominantly represented by the Nigerian Association of Resident Doctors (NARD) and the Joint Health Sector Unions (JOHESU), has underscored the urgent need for comprehensive reform in the nation’s healthcare system. Nigeria’s public health institutions face a myriad of challenges, including inadequate manpower, chronic underfunding, poor management, outdated infrastructure, demotivated and underpaid staff, misconceptions about medical professions, brain drain, and inter-professional rivalry. The persistent failure of successive governments to address these issues effectively has fueled a cycle of industrial unrest, resulting in the closure of hospitals and the denial of quality medical services to the citizens.
Research has consistently shown that frequent medical worker strikes lead to the closure of public health institutions, depriving Nigerians of access to essential services. Pregnant women, individuals with chronic ailments, and parents of children under-five years old bear the brunt of these disruptions, often being the most vulnerable in such circumstances. The consequences extend beyond immediate access issues, contributing to increased morbidity and mortality, loss of confidence in health institutions, and a reliance on alternative, often less effective, options. An investigation revealed that poor staff welfare, inadequate salaries, mismanagement, and the government’s failure to honor agreements are the primary triggers for these strikes. The reluctance of the government to implement the National Health Act, address salary disparities, and ensure favorable working conditions further exacerbates the situation. Stakeholders argue that unless these fundamental issues are comprehensively addressed, the sector will continue to grapple with the problem.
Ongoing and impending strikes, and the call for government commitment.
Despite the grim consequences of previous strikes, the healthcare sector in Nigeria faces the looming threat of more strikes. NARD, in particular, has issued warnings of a nationwide strike if the ‘one-for-one replacement policy’ is not enforced. The Enugu State University Teaching Hospital (ESUTH) chapter has already initiated a strike, highlighting the urgency of the situation. Dr. Dele Abdullahi, the President of NARD, emphasized that the government’s failure to meet their demands by January 2024 could result in further disruptions and a loss of industrial harmony. Dr. Abdullahi, the President of NARD, emphasized that strikes are a last resort to garner the government’s attention and fulfill promises made to healthcare workers. He pointed to the government’s negligence, insensitivity to workers’ trials, and lack of sincerity in implementing documented agreements as major contributors to its recurrence.
Abdullahi called for practical measures, including improving working conditions, massive staffing increases, commensurate remuneration, and upgrading facilities to enhance efficiency and job satisfaction. Experts in the healthcare sector stress the need for the government to demonstrate commitment by increasing funding to the sector. Dr. Dare Godiya Ishaya, a specialist in Internal Medicine, highlights the poor ranking of Nigeria’s healthcare system globally, attributing it to consistent underfunding. The annual budgetary allocation to health has consistently fallen short of the 15 percent agreed upon in the Abuja Declaration of 2001, hindering the sector’s growth and competitiveness.
Addressing disparities in doctors’ salary structures.
Dr. Kingsley Chiedu Amibor, a former National Chairman of the Association of Hospital and Administrative Pharmacists of Nigeria, emphasizes the need for a unified salary structure in the healthcare sector. He advocates for a return to the status quo, where medical doctors, pharmacists, and other professionals had a single spine salary structure, reducing the likelihood of inter-professional disputes over salary increases. Amibor believes that this change, coupled with improved training and upgrading of hospitals, would significantly reduce the frequency of strikes.
To curb the recurring strikes in the sector, a holistic approach is necessary. First, the federal government must prioritize healthcare by increasing funding to meet the 15 percent allocation agreed upon in the Abuja Declaration. This commitment is essential for addressing infrastructure deficiencies, remuneration disparities, and overall improvement in the healthcare system. Also, governments at all levels should honor agreements reached with medical workers promptly. The failure to implement agreements erodes trust and contributes to the cycle of strikes.
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As well, the government should reintroduce a unified salary structure for medical practitioners to eliminate interprofessional rivalry and create a fair and transparent system that encourages collaboration. Then, it should invest in the training of leaders in the field, emphasizing interpersonal and leadership skills. This will enhance the capacity of these professionals to provide effective leadership and collaboration within health institutions. In addition, medical facilities must be modernized and upgraded with state-of-the-art equipment to enhance service delivery. Providing a conducive working environment will contribute to job satisfaction and reduce the likelihood of strikes. Finally, the federal government should actively implement the National Health Act to address existing challenges and improve the overall quality of medical services.