With high unemployment rates, inflation, ongoing insecurity in various parts of the country, and the COVID-19 pandemic on its issue list, the last thing Nigeria needs is a doctors’ strike. But that is exactly what happened on Thursday as the National Association of Resident Doctors (NARD) began an indefinite strike to protest poor working conditions and pay. Resident doctors in Nigeria are medical school graduates training and working as specialists, and make up almost half of all working doctors in the country. This is the third time the doctors have gone on strike in the past year. This also comes as the country rolls out vaccines, acquired via the COVAX Facility — led by the World Health Organisation (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Vaccine Alliance — to frontline health workers and the elderly, before the rest of the population. Why are Nigerian doctors on strike? There are many reasons behind the strike. Nigeria’s health sector is severely underfunded which means there isn’t enough money to maintain public health infrastructure or improve health worker welfare. This has led to doctors not only being paid poorly but thousands of doctors are also being owed as much as six months’ pay. Meanwhile, despite being frontline workers in the fight against COVID-19, the Nigerian government has only offered N5,000 (~$13) as hazard allowance to the doctors. Doctors are also protesting lack of life insurance coverage and demanding that the government reviews the law regulating Postgraduate Medical Training (PMT) in Nigeria, which was established in 1979 and has never been reviewed, according to NARD. But the biggest reason behind these frequent doctors' strikes, arguably, is the fact that the Nigerian government has constantly failed to honour previous agreements it has made with NARD in the past to resolve these issues. “I am aware that out-of-pocket payment for health constitutes over 70% of total health expenditure,” said President Muhammadu Buhari at the opening of a new health care facility in 2017. “My presence here today demonstrates our administration’s commitment to put [the] health of Nigerians as a top priority.” 3 facts you should know about health care in Nigeria Nigeria has only 3.8 doctors per 10,000 people — or 0.38 doctors per 1,000 people. According to the Global Goals’ recommendation, a series of targets set by the United Nations in 2015, countries should aim for a minimum of 1 doctor per 1,000 people. In other words, Nigeria would need at least 200,000 doctors to sufficiently cater for its 200 million people. Health care in Nigeria is severely underfunded — Nigerian governments have consistently allocated under 10% of their budgets to health care despite a 2001 declaration by African heads of state — known as the Abuja Declaration — to allocate at least 15% of their national budgets to health care. Of the 42,000 registered doctors in the country, 16,000 are resident doctors (who are currently on strike). Who is most affected by these strikes and why? Millions of Nigerians will be affected by this strike as the disruption will affect many health care services across the country. Routine immunisation and malaria programmes have already been affected by the redirection of resources to tackling the coronavirus pandemic. People in remote and rural areas — 48% of the Nigerian population — who already have limited access to any health care services will also be significantly affected by this strike and others like it. What impact is it having on Nigerians? All over the country, millions of Nigerians already do not have access to potential lifesaving health services and thousands of doctors across the country do not have the resources needed to function at their best capacity. This strike plunges an already struggling public health care system in the country into further crises and worsens the quality of life for Nigerians all over the country. People living with disabilities and HIV, orphans, homeless Nigerians, and other at-risk communities will potentially bear most of the impact of the doctor’s strike. “We are not insensitive; we hope that the government and those in charge of the discussion with NARD will take it seriously, with a view to settling the issues at stake. To our patients, we are very sorry that you have to suffer this epileptic irregular health care service delivery; we have taken an oath to take care of you,” said Dr. Enema Amodu, Chairman of the Abuja chapter of the National Medical Association (NMA). He added: “But if a doctor is not in a sound state of mind and is not happy with what he or she is getting from the job, the doctor may not be in the right frame of mind to discharge his or her duty right. And this will invariably affect you; by the time we get placed properly, remuneration and other welfare matters and facilities that we need to serve you, we will be able to serve you better with productive results,” How does this strike relate to the mission to end extreme poverty? Good health and well-being and access to quality health care are important pillars of the United Nations’ Global Goals, which align with Global Citizen’s mission to end extreme poverty in the world. As the country with the highest poverty rate in the world, as well as the most populous nation in Africa, ending extreme poverty in Nigeria is crucial to this global mission. Strikes like these create many socio-economic ripple effects that push more people into poverty. What action can we take? Many of the problems facing the Nigerian health care system can be linked to a historic lack of funding which persists today — still only 3.7% of Nigeria’s 2021 budget is allocated for health care, despite the COVID-19 pandemic. The country’s doctor shortage, poor health care infrastructure and worker welfare, high rate of out-of-pocket expenses, and its struggles with the coronavirus pandemic, among other things, can be traced back to the dearth of funding for the health sector. This is why it is important that we call on the Nigerian government to ensure health equity by increasing funding to the country’s health care system, which can help solve a lot of the issues within the space. We must also call on Nigerian legislative bodies and medical agencies to review existing processes and policies around health worker welfare, especially given the effect of the coronavirus pandemic. Source
