By Jimoh Abibat

The indefinite strike declared by the Nigerian Association of Resident Doctors (NARD) on November 1, followed by the Joint Health Sector Unions (JOHESU) announcing their own nationwide industrial action, marks one of the most serious breakdowns in Nigeria’s health sector in recent years. What we are witnessing is not a routine labour dispute, but a deep crisis that exposes years of neglect, chronic underfunding, and structural failures that successive administrations have refused to confront.

For NARD, the strike is rooted in the federal government’s continuous refusal to honour the Collective Bargaining Agreements (CBA) it voluntarily entered into. A major grievance is the non-implementation of the long-promised review of the Consolidated Medical Salary Structure (CONMESS), which has become outdated and insufficient given current economic realities. Many resident doctors have also expressed frustration over unpaid allowances running into several years, irregular payments, and the failure to address issues of career progression and the recruitment of adequate manpower.

JOHESU’s struggle is the same as NARD’s. Their industrial action arises from the government’s refusal to implement the long-delayed adjustment of the Consolidated Health Salary Structure (CONHESS). The salary structure, which covers nurses, laboratory scientists, physiotherapists, radiographers, community health workers, and other essential cadres, has not been properly reviewed for over a decade. Health workers argue that while other public sector employees have benefited from adjustments, their demands continue to be sidelined, creating inequality within the health system.

Both NARD and JOHESU insist that the federal government has repeatedly broken promises, signing agreements in the heat of previous strikes only to abandon them once workers resume duties. After years of such patterns, trust in government has collapsed almost completely, leaving workers with no option but indefinite industrial action.

One of the most disturbing realities is that an entry-level graduate of medicine, nursing, dentistry, or other core health fields earns less than ₦400,000 in most government hospitals, and even less in private facilities. In a country battling some of the worst inflation rates in decades, the purchasing power of these salaries has collapsed drastically. Food, transportation, housing, and essential commodities have become increasingly unaffordable, pushing health workers who carry out some of the most demanding and stressful work in society to the edge of poverty.

The result is predictable with obvious mass burnout, frustration, constant industrial disputes, and a migration of skilled professionals. Even before graduation, many medical and health-related students already see working abroad as their only path to a dignified career. The mass migration of doctors, nurses, and other essential workers continues to weaken a system already stretched beyond its limits.

Doctors, nurses, midwives, and laboratory staff often work excessive hours, sometimes without proper equipment, and under deteriorating facilities. This increases burnout, medical errors, and job dissatisfaction. Many health workers face stagnated career paths, irregular promotions, or nonstandard recruitment practices that create inequalities and institutional frustration.

Rather than addressing the legitimate concerns raised by health workers, the Tinubu administration has attempted to adopt restrictive policies, including proposals to compel medical graduates to work for a certain number of years in Nigeria before being permitted to leave the country. The government justifies these policies as patriotic measures to curb brain drain; however, in reality, this approach reflects a refusal to confront the deeper issues undermining the health sector.

Patriotism cannot be legislated. No government can force workers to remain in a country where their labour is undervalued, their working conditions degraded, and their safety and welfare ignored. Retention must be earned through sound policies, adequate remuneration, quality infrastructures, and respect for the dignity of workers. Without these, compulsory service becomes nothing more than coercion, and coercion has never solved structural problems.

The health institutions in Nigeria are severely underfunded and chronically understaffed. Many hospitals lack basic equipment, drugs, and consumables needed for even routine medical care. Wards are overcrowded, medical equipment is outdated or malfunctioning, and health workers often improvise just to carry out basic procedures.

Despite thousands of students graduating annually from medical schools, nursing schools, and other health institutions, the number of professionals available to staff public hospitals continues to decline. According to the State of Health Report 2024 by the Federal Ministry of Health, Nigeria has 2.9 doctors per 10,000 people, which is 1 doctor to 3,474 people. Many young doctors leave immediately after their housemanship, nurses and other health workers emigrate en masse. Senior specialists are increasingly relocating to work in better-funded systems where their skills are valued.

Underfunding does not happen by accident; it is the result of corrupt capitalist programmes that seek to underfund social needs, and it diverts resources to sectors where it is easy to amass profit and wealth. With governments allocating only a small fraction of the national budget to health year after year, it is clear that the well-being of the population has never been treated as a national priority. The consequence is a broken system where the burden falls on the very workers the government now attempts to restrict, underpay, and overwork.

The ongoing strikes must be understood not only as demands for improved wages, but as a deeper struggle over whose interests the Nigerian state represents. The health sector is collapsing because public welfare is subordinate to political and private interests. By underfunding public hospitals, failing to improve infrastructure, and neglecting worker welfare, the state reinforces a system that benefits private hospital owners, political elites who travel abroad for healthcare, and profit-driven interests.

Health workers are fighting not only for themselves, but for a healthcare system that works for ordinary Nigerians. When doctors and nurses demand better pay and improved conditions, they are also demanding the kind of investment that would ensure that patients receive quality care. Their strike is therefore a fight for the very survival of public healthcare.

The fact that many Nigerians now rely on underfunded hospitals, overstressed workers, and obsolete equipment is a clear indication that health has been deprioritized as a public good. Without a major shift toward funding, democratising the sector, and prioritising human lives over profit or political convenience, the crisis will continue to deepen.

The Tinubu-led administration must honour the full terms of the agreements it has already signed with NARD and JOHESU, not selectively or partially.

We call for:

• An immediate review of CONMESS and CONHESS to reflect current economic realities and global standards.
• The government must significantly increase health funding, prioritizing infrastructure, modern equipment, and sufficient staffing.
• Improvement in wages, working conditions, and career progression is the only effective strategy for curbing brain drain.
• Democratic election of Health workers to be included in decision-making processes affecting their work, pay, and welfare.

The strikes by NARD and JOHESU expose the complete breakdown of Nigeria’s capitalist, neoliberal healthcare system. A system sustained only by the sacrifice of exploited and underpaid workers. Their action is not just about wages; it is a fight for dignity and a public health system that serves the majority. As long as healthcare remains underfunded and controlled by a ruling class that prioritises profit over human life, the crisis will deepen. Only through democratic control of society’s resources by the workers who create the wealth can Nigeria build a truly accessible, functional, and humane healthcare system.