INCESSANT STRIKES BY MEDICAL HEALTH PERSONNEL IN NIGERIA’S HEALTH SECTOR: THE WAY FORWARD
Gabriel Omachi
Abstract
Strikes by medical personnel remain a global challenge, with severe consequences for healthcare delivery and the doctor-patient relationship. They serve as legitimate tools in labour negotiations when collective bargaining fails. However, in the healthcare sector, these strikes often create a moral dilemma, as health workers must reconcile their Hippocratic responsibilities with their rights as employees. This conflict brings ethical principles like respect for autonomy, justice, and beneficence into tension. In Nigeria, the frequency and impact of strikes by healthcare workers are amplified by systemic challenges in the health sector, necessitating urgent and sustainable solutions.
Introduction
A strike is the cessation of work by employees, often in response to unresolved grievances regarding pay, working conditions, or other labour issues. While a strike can be an effective tool to demand concessions from employers, its implications in the health sector are far-reaching, as lives may be lost when medical services are unavailable.
The history of strikes in Nigeria dates back to the 1945 General Strike, which symbolized a broader anti-colonial struggle. Today, strikes in Nigeria’s health sector expose deeper systemic issues, including underfunding, poor infrastructure, and inadequate human resources. With only 0.38 doctors per 1,000 people, Nigeria’s doctor-patient ratio falls significantly short of the global target of 1:1,000 recommended by the United Nations.
Healthcare strikes disproportionately affect vulnerable populations, particularly in a country where alternatives to public healthcare are limited. North-Central Nigeria, for example, recorded 42 healthcare strikes between 2000 and 2020, with doctors accounting for 52.3% of these strikes. Resident doctors are often at the forefront, primarily due to unpaid salaries, poor working conditions, and delayed implementation of agreements by the government.
Causes of Strikes in Nigeria’s Health Sector
Healthcare worker strikes in Nigeria arise from multiple systemic and administrative challenges, including:
- Non-implementation of Agreements: Failure by government authorities to honor negotiated agreements with healthcare workers.
- Poor Remuneration and Welfare: Inadequate salaries, delayed payments, and lack of incentives for health workers.
- Infrastructural Deficiencies: Substandard facilities and a lack of essential medical equipment and supplies.
- Inter-professional Rivalries: Disputes between doctors, nurses, and other healthcare professionals over roles and responsibilities.
- Poor Communication: Ineffective leadership and inadequate channels for addressing grievances.
The Right to Strike as a Fundamental Human Right
The right to strike is recognized as a fundamental human right under international labour laws, including conventions by the International Labour Organization (ILO). Lord Wright, in 1942, emphasized that the right to strike is integral to collective bargaining. However, in essential services like healthcare, this right is often restricted to balance the interests of workers with the societal need for uninterrupted medical care.
Moral Dilemmas Surrounding Health Worker Strikes
The ethical arguments surrounding healthcare strikes are complex. On one hand, workers are entitled to fair wages and humane working conditions, which may necessitate strikes when negotiations fail. On the other hand, the disruption of medical services poses a significant threat to human lives, raising concerns about justice and beneficence. For many, health worker strikes are seen as a moral failure, as they disproportionately affect the poor who cannot afford private healthcare.
Recent Developments
Recent strikes, such as the August 2023 strike by the Nigerian Association of Resident Doctors (NARD), highlight ongoing challenges. Key demands included the implementation of the Medical Residency Training Act, improved hazard allowances, and the payment of salary arrears. Despite some resolutions, the underlying issues persist, indicating systemic failures. Additionally, the enactment of the 2022 National Health Insurance Authority Act, which aims to achieve universal health coverage, has yet to address funding and implementation bottlenecks.
Way Forward
Resolving incessant strikes in Nigeria’s health sector requires a multi-pronged approach:
- Implementing Agreements: The government must demonstrate a commitment to honouring agreements with healthcare unions.
- Increased Funding: Allocate at least 15% of the national budget to health, in line with the Abuja Declaration, to address infrastructure deficits and improve working conditions.
- Strengthening Legislation: Fully implement the National Health Act and the Medical Residency Training Act to support healthcare delivery and workforce training.
- Improved Communication: Establish effective channels for resolving disputes between government authorities and healthcare workers.
- Capacity Building: Invest in the training and retention of healthcare workers to address the brain drain and improve the doctor-patient ratio.
Conclusion
The incessant strikes by healthcare personnel in Nigeria reflect deeper structural problems in the sector. Addressing these requires collaborative efforts between the government, healthcare workers, and other stakeholders. A national stakeholders’ conference could serve as a platform for dialogue and consensus-building. Ultimately, sustained investment in healthcare infrastructure, workforce development, and policy implementation is essential to reducing the frequency of strikes and improving health outcomes in Nigeria.
