Nigeria’s health sector gains amid strikes

By Folasade Akpan

Nigeria’s health sector in 2025 recorded notable progress in infrastructure, emergency care, insurance expansion, and service utilisation, yet persistent strikes by doctors, nurses, and allied health workers exposed unresolved labour tensions threatening reforms.

Under the Health Sector Renewal Investment Initiative, the Federal Government commissioned oncology centres, expanded emergency services, improved immunisation coverage, and cleared several legacy arrears owed to health workers, signalling significant investment in healthcare reform.

In spite of these gains, waves of strikes disrupted federal hospital services, left patients stranded, and highlighted deep-rooted tensions between authorities and health sector unions, exposing the fragile nature of reforms even with investment and policy advances.

In practice, 2025 was marked by repeated industrial actions, with several unions halting hospital operations, making labour disputes the defining feature of the year, even as reforms and infrastructure improvements continued across the country.

One of the most consequential disruptions came from the Nigerian Association of Resident Doctors, NARD, which launched an indefinite nationwide strike on Nov. 1 over unresolved welfare and structural issues affecting federal health institutions.

After 29 days of paralysis in tertiary hospitals, NARD suspended the strike following a series of conciliatory meetings with the Federal Government, signalling temporary resolution but leaving critical issues still unaddressed in hospitals.

NARD National President Dr Mohammad Suleiman, announced the suspension on Nov. 29 after an extraordinary National Executive Council meeting, citing a Memorandum of Understanding that outlined the status of the association’s 19-point demands.

Suleiman explained the suspension was conditional: “The NEC resolved to suspend the strike for four weeks to allow room for dialogue, while ensuring follow-up on implementation of pending welfare and structural demands,” he said.

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Promotion arrears remained unpaid because Chief Medical Directors and Managing Directors had not completed compilations, though a four-week deadline was agreed between Nov. 30 and Dec. 31 for clearing outstanding salary obligations.

On specialist allowances, directives from the Office of the Head of the Civil Service and the National Salaries, Incomes and Wages Commission were expected to initiate implementation, signalling partial progress while systemic delays persisted across federal institutions.

The MoU also covered failed or omitted payments for the 25/35 per cent review and accoutrement allowances, while upgrading eligible residents continued following the release of the Post-Assessment Tool, addressing long-standing financial grievances.

Interim directives were issued to curb excessive call duties and limit “obnoxious clauses” in locum engagements, with committees reviewing policies expected to submit comprehensive recommendations within two months to improve doctors’ work conditions.

“The countdown for the four weeks shall start on Monday and serve as a daily reminder to Nigerians and the Federal Government to use this window fully and justly,” Suleiman warned.

On Sept. 15, resident doctors in the Federal Capital Territory embarked on an indefinite strike following a seven-day warning strike beginning Sept. 8, citing unpaid salaries, delayed promotions, poor infrastructure, and severe manpower shortages.

ARD President Dr George Ebong noted hospitals were overstretched and under-equipped, with some doctors handling up to 60 patients overnight, highlighting operational pressures that exacerbated strikes and strained patient care throughout the year.

Members of the National Association of Nigerian Nurses and Midwives (NANNM) staged a seven-day warning strike on July 30 over decades-old welfare, allowances, and career progression demands, signalling broad dissatisfaction across health sector cadres.

Allied health workers followed, with the Joint Health Sector Unions declaring an indefinite nationwide strike on Nov. 14 over a 12-year delay in implementing the adjusted Consolidated Health Salary Structure (CONHESS), intensifying sector-wide unrest.

The Nigeria Labour Congress backed the industrial action on Dec. 2, warning of escalation if demands were ignored, showing coordinated pressure from organised labour on the government to address systemic failures in healthcare.

Beyond unions, faith-based and professional groups expressed concerns over the ethical and human cost of strikes, with the Islamic Medical Association of Nigeria warning that patients often bear the heaviest burden.

Health analyst Dr Francis Ayomo noted strikes had “very bad and very negative” impacts on health outcomes, leaving patients to either seek private care, resort to informal providers, or self-medicate with potential life-threatening consequences.

Ayomo said recurring strikes reflected failure to address human resource issues sustainably, criticising authorities for implementing temporary fixes without post-mortem reviews, perpetuating cycles of unrest and undermining healthcare progress across Nigeria.

Government officials acknowledged the scale of the problem.

Minister of State for Health, Dr Iziaq Salako, warned that recurring strikes threatened Universal Health Coverage goals, stressing dialogue as the preferred path while addressing root causes.

Coordinating Minister of Health Prof. Muhammad Pate noted ongoing reforms were restoring confidence and addressing longstanding grievances, citing measures under President Tinubu’s administration to improve working conditions and clear arrears owed to healthcare workers.

Pate highlighted progress including raising retirement age for skilled workers, clearing 2023 arrears, processing new hazard allowances, and settling more than N10 billion owed under the 2025 Medical Residency Training Fund, demonstrating tangible government commitment.

He added that CONHESS and CONMESS salary relativity adjustments were being institutionalised, while Collective Bargaining Agreement negotiations with NMA, JOHESU, and NANNM continued, reflecting a multi-pronged approach to resolving labour tensions in the sector.

For patients like Blessing Yakubu, referred to federal hospitals during strikes, reforms remained fragile.

“We had to borrow money for private clinics because we had no choice,” she said, illustrating persistent gaps in service delivery.

As Nigeria closes 2025, progress in healthcare is evident, yet unresolved labour disputes remain.

Citizens warn that until agreements move from paper to practice, each strike suspension risks being a temporary “quick fix” rather than lasting solution.  NAN Features