Nigeria’s Health Sector Needs Better Administration

Nigerian hospitals are once again facing empty wards and shuttered outpatient units, as resident doctors under the Nigerian Association of Resident Doctors (NARD) have given the government until August 10 to meet a long list of demands or face another indefinite strike. This is the latest chapter in a pattern that has repeated so often in recent years that many Nigerians now brace for it the way they brace for fuel scarcity or ASUU strikes.

To understand how Nigeria got here, it helps to look back at recent history. Resident doctors, who make up the backbone of clinical care in teaching hospitals, last embarked on a full nationwide strike on November 1, 2025. That action lasted 29 days and paralysed services across roughly 91 teaching hospitals nationwide before it was suspended following a memorandum of understanding with the government after repeated failures to honour earlier agreements. Before that, there had been a five-day warning strike in September 2025, and further back, a seven-day warning strike in August 2024 tied to the abduction of a colleague. Altogether, resident doctors have stopped work multiple times, totalling 51 days since the inauguration of President Bola Tinubu in May 2023.

The Nigerian Medical Association, the umbrella body that includes consultants and general practitioners, issued its own 21-day ultimatum in July 2025 after rejecting a government circular it said undercut previous salary agreements. The association rejected the National Salaries, Incomes and Wages Commission circular dated June 27, 2025, calling it a violation of previous collective bargaining agreements with the government. That standoff was eventually shelved after a revised pay circular was issued, but the underlying grievances, arrears, allowances and stalled negotiations never fully went away.

During the November 2025 strike, the Minister of State for Health, Iziaq Salako, publicly apologised to Nigerians and said President Tinubu had directed immediate action. The federal government eventually approved close to twelve billion naira in arrears and pledged mass recruitment of health workers.

Did doctor welfare actually improve? Only partially. NARD itself has pushed back hard on government claims of progress, insisting that announcements of payment were not the same as money actually landing in doctors’ accounts, “an announcement of intent is not a substitute for a credited salary,”  noting the government was still compiling lists of arrears owed across several hospitals. Months later, some of those same allowance and arrears issues resurfaced in the current August ultimatum, suggesting that whatever was resolved was resolved only on paper, or only for a portion of affected doctors.

This is the part that should worry every Nigerian, not just those in the medical profession. The cycle bears an uncomfortable resemblance to the decades-long stand-off between ASUU and successive governments. Promises are made under pressure, strikes are suspended rather than resolved, and within months the same demands return, sometimes with new grievances layered on top. In both cases, agreements signed with fanfare quietly gather dust, and the people who suffer most, students in one case, patients in the other, are treated as leverage rather than stakeholders.

Lasting solutions will require more than emergency meetings and last-minute cheques. Health sector unions and independent observers have repeatedly called for full implementation of collective bargaining agreements rather than partial disbursements, a transparent and time-bound payment system that does not require doctors to strike before arrears are released, and a functional joint monitoring mechanism involving government, NARD and the NMA to track implementation after each agreement, so that “the strike ended” does not simply mean the crisis went quiet for a few months. Structural investment matters too: more funded residency slots, better staffing ratios and stronger security for health workers on duty, since NARD has also flagged rising assaults on doctors as a serious concern requiring a national protocol.

There is also a real danger in treating this as a purely administrative dispute. When resident doctors walk away from hospitals, it is not simply fewer hands on deck. Residents occupy a critical middle layer in clinical care. House officers, the newest and least experienced doctors, are already stretched thin and rely heavily on residents for supervision and hands-on decision-making. Consultants, meanwhile, are meant to provide oversight and guidance, not to personally run wards, manage emergencies or handle the bulk of patient care themselves. Removing residents from that structure does not slow down the system, it makes it dangerously unbalanced, with overworked juniors making decisions beyond their experience and senior consultants unable to compensate for the gap. That is precisely why extended strikes translate quickly into deaths that never make the news.

NARD’s own figures point to a mass exodus, with well over sixteen thousand doctors having left Nigeria in the past six years, a number that now outpaces annual graduation figures from the country’s medical schools. The recent case of Dr Salamat Ahuoiza Aliu-Ibrahim, Nigeria’s first indigenously trained female neurosurgeon, captures just how steep a price this exodus exacts.

After years of training entirely within Nigeria and a fellowship at Boston Children’s Hospital, she returned home to practice at the University of Ilorin Teaching Hospital, only to leave again in search of better professional prospects abroad. Unable to secure a neurosurgery residency slot in the United States, she pivoted into paediatrics, effectively restarting her medical career from residency level despite having already reached consultant status in a highly specialised field. Her trajectory has stirred debate online precisely because it is not an isolated story: it is what the exodus looks like at the individual level, one highly trained specialist at a time, even as regions of the country are left with only a single neurosurgeon to serve entire communities.

That shortage is echoed at the state level too. In Akwa Ibom, the state chapter of the NMA recently used its annual conference to press Governor Umo Eno’s administration to go beyond its recently approved medical school at Akwa Ibom State University. Chairman Prof. Aniekan Peter argued the state needs at least seven medical training institutions, pointing out that recent efforts to recruit 400 doctors and 700 nurses fell embarrassingly short. He said this is evidence that treating medical education as an investment rather than a burden is now urgent and unavoidable.