Doctor and healthcare worker strikes are a global phenomenon reported both in highly industrialised and developing countries. Healthcare worker strikes are of growing concern for international and local health authorities. They represent a barrier to achieving the universal health coverage as envisaged by the World Health Organisation.
WHO envisions ‘a sufficient capacity of well-trained, motivated health workers’ to assist in achieving the United Nations sustainable development goal of ensuring “healthy lives and promote well-being for all ages.”
In a recent paper I examined the issue of whether health care workers are ethically or morally justified in taking strike action.
The key points I raise are:
- Doctor and healthcare workers strikes are ethical and are supported by national and international laws and regulations.
- The social contract between medicine and society has been altered by the rise of consumerism in healthcare and ought to be re-evaluated.
- The main reasons doctors and health care workers strike are poor wages and working conditions, infrastructural deficiencies, personal safety and security, frequent policy changes, poor leadership; leading to disempowered and disillusioned healthcare workers.
- The primary consequences of these strikes is not increased patient mortality, but disruption of healthcare service delivery.
- The impact of strikes by doctors and health care workers can be minimised by providing emergency and critical care to patients based on minimum service agreements before strikes.
In view of these facts Nigerians need to move beyond the issue of the legality or illegality of strikes to urgently find a lasting solution.
All stakeholders involved in health provision in the country need to put their differences aside and map a way forward to address the systemic issues facing the sector. Health care is in crisis in Nigeria. The country can’t afford continue poor funding of the health sector – and incessant strikes.
Behind the strikes
Incessant strikes have become the bane of Nigeria’s health sector. In August 2021, the National Association of Resident Doctors embarked on its fourth strike within one year. They claimed that the government hadn’t implemented a memorandum of understanding that had been agreed upon following previous strikes in 2020 and 2021.
Doctors and other healthcare worker strikes in Nigeria occur at national, state, and local hospital levels. Reasons for those strikes sometimes include power struggles and leadership tussles between different healthcare workers. These represent struggles for dominance or equal pay within the healthcare sector. They are usually supported by various groups, like the Joint Health Sector Unions, and others purporting to protect their different memberships’ interest.
But there are a host of reasons beyond these tensions between unions that doctors and other Nigerian Healthcare workers have given for going on strike. They include:
- poor staff welfare,
- salary and leadership/management conflicts, and
- government’s inability to implement agreements.
These factors were reflected in the communique issued by National Association of Resident Doctors in March 2021, before they embarked on their strike the next month.
Strikes by doctors are usually met with public outcries, and appeals for them to abide by their ethical obligations under the Hippocratic oath .
My view, however, is that it’s not that simple. Doctors are employed under agreements such as the recent Medical Residency Training Act, 2017. This means that they are employed under rules that apply to all public sector employees.
Even in the private sector there are constitutionally protected bargaining rights binding on all employers and employees.
Resolving the perennial doctors’ strikes in Nigeria requires fiscal and ethical solutions as well as a moral commitment to improving health and welfare of all Nigerians.
All stakeholders involved in the regulation of the medical profession in Nigeria need to come to the table.
I recommend that an all-stakeholders conference would be a good start. A conference between all healthcare workers unions and Associations and government employers (both federal and State) in Nigeria is long overdue.
It would, firstly, enable all groups or unions representing healthcare workers to air their views. This would create the space for them to arrive at a unified decision binding on all healthcare workers rather than the current patchwork of grievances and actions.
The conference would need to involve a wide range of actors. This would include:
- the National Association of Resident Doctors which represents about 16,000 trainee doctors – that’s 45% of registered doctors in Nigeria,
- the Nigerian Medical Association which represents medical doctors in public and private practice
- the Medical and Dental Consultants Association of Nigeria which represents all registered specialist/consultant doctors,
- the Medical and Dental Council of Nigeria which is responsible for registration and regulation of all Medical doctors and dentists and deployment of House Officers for Internship,
- the Joint Health Sector Unions, which represents over 90% of all other healthcare workers groups in Nigeria. These include physiotherapists, occupational therapist and laboratory scientists.
The conference should also involve those regulating and funding the medical profession in Nigeria such as government employers from both the Federal and State levels.
The conference agenda would need to include a commitment to resolve all outstanding issues, such as the 10-items raised in the National Association of Resident Doctors communique of demands of April 2021.
It would also need to establish a minimum service level agreement to provide basic healthcare services during strikes.
Other issues requiring a permanent solution include increased funding for the health sector by both federal and state governments. In this case, the federal government should commit to increasing health expenditure in the federal budget to at least 5%. According to a World Bank statistics from 2018. Nigeria spent only about 3.89% of its budget on health.
This is far short of the 15% of budgetary expenditure for health agreed by African heads of State during the The Abuja Declaration in 2001.
Increased funding of the healthcare sector would help the government honour agreements and memorandums of understanding between itself and all healthcare workers. It would also ensure the effective implementation of laws such as the Medical Residency Training Act.
This would go a long way towards reducing the incessant doctor and healthcare worker strikes in Nigeria. It would also move Nigeria closer to meeting global commitments to healthcare provision, including universal healthcare.