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Nigerian doctors walk off the job again. Overstretched and underpaid, many have left for overseas

By Chinedu Asadu

Resident doctors in Nigerian public hospitals on Wednesday embarked on their second strike this year to protest at salaries in arrears and to demand improved pay and working conditions.

The Nigerian Association of Resident Doctors declared the “total and indefinite strike … having considered all the numerous ultimatums, appeals and engagements with the government,” Dr Innocent Orji, the group’s president, said in a statement issued after their meeting on Tuesday night.

Strikes by doctors in Nigeria are common and the latest could shut down some healthcare services in critical wards where they work as graduate trainees across public hospitals in Africa’s most populous country. The doctors are medical school graduates who provide urgent and critical care across under-staffed public hospitals.

An average of 200 resident doctors in Nigeria have relocated abroad every month over the last two years, seeking better pay, Dr. Orji told The Associated Press. Their positions are left vacant, further worsening the relatively affordable healthcare services in public hospitals in the country of more than 210 million people.

The World Health Organization reports that Nigeria has a ratio of four doctors to 10,000 patients as of 2021. However, the Nigerian Medical Association told the Associated Press their records show it is a 2:10,000 ratio generally and 1:10,000 in some rural areas, making the country’s healthcare burden one of the worst globally.

In addition to Nigeria’s worsening hardship caused by surging inflation and an end to gas subsidies, the resident doctors’ president said their salaries had not increased since negotiations in 2009. The value of the local currency against the U.S. dollar has fallen by 480% since then.

A consultant, a highly qualified senior doctor, earns less than $900 a month while those with about five years of experience earn between $400 and $600.

“We are having a massive brain drain in the health sector. It has gotten to the extent of doctors dying and breaking down ? it has never been this bad,” Dr. Orji said.

The working conditions are worse for doctors in state-owned hospitals like the Abia State University Teaching Hospital where doctors are owed 24 months’ salary in arrears. Out of the seven months so far this year, they have only been paid for June, said Dr. Erondu Nnamdi Christian, the head of the resident doctors’ association at the facility.

Although the country is Africa’s top oil producer and has the continent’s largest economy, Nigeria’s public health sector has been underfunded for many years, leaving doctors to often go on strike before they could get the government to the negotiation table.

“We cannot do without resident doctors (and) what they are asking in order to be able to provide the services that people require in Nigeria is not much (but) the federal and state governments do not prioritize healthcare,” said Ifeanyi Nsofor, of the U.S.-based Atlantic Fellows for Health Equity, who has conducted extensive research on healthcare delivery in Nigeria.

The United Kingdom is the preferred choice destination for many Nigerian doctors moving abroad, the local doctors’ association said. In the year leading to September 2022, Nigerian nationals were the second-largest category to receive the U.K. “Skilled Worker – Health and Care” visa, accounting for 8,520, or 14% of the total, government statistics show.

At the Federal Medical Center in Nigeria’s Abia state, Dr. Chigozie Ozurumba said doctors can only hope that things get better for them with the strike as the last option.

“The Nigerian doctor is an unhappy doctor,” said Dr. Ozurumba. “It is an existential threat.”