With a myriad of industrial actions, operational challenges and welfare issues to contend with, the health sector is deeply traumatised and yearning for a new lease of life. To reduce all these challenges to the barest minimum, the government, stakeholders say, must also be deliberate in addressing topical issues like headship of public health facilities, which has made the sector topsy-turvy, NKECHI ONYEDIKA-UGOEZE reports.

Incessant health workers’ strikes have become constant features of the country’s health sector. Sadly, these work disruptions, which pose severe economic and social consequences, are most often driven by issues such as unpaid salary arrears and allowances, poor infrastructure, and demands for better welfare, among others.

For decades, these agitations within the public health sector, which are often driven by issues like unpaid salary arrears and allowances, poor working conditions, poor infrastructure, and demands for better welfare, have had severe economic and social consequences.

Unfortunately, successive administrations have consistently failed to abide by or fully implement the Collective Bargaining Agreement (CBA) entered into with health worker unions, leading to chronic industrial instability in the sector.

From doctors to nurses, pharmacists, laboratory scientists and other medical professionals, industrial action has become almost a permanent feature of Nigeria’s health sector. Hardly does one strike end before another begins.

According to reports from 2023 reference studies on the effect of industrial action on healthcare delivery in Nigeria, the general idea behind industrial action in the health care sector is that, workers believe that, by coming together as a team, they will be able to fight for their rights against any economic exploitation and social injustice that could be meted on them by their employers with respect to the job.

However, the incessant strike by mostly resident doctors, the Joint Health Sector Unions (JOHESU) and other health professionals, led to significant disruptions in service delivery, causing substantial financial strain on patients, their families and the country.

Strike actions generally result in colossal loss of lives and revenue. The worst hit by it are the Nigerian masses, who cannot afford the services of private health care providers but only rely on public health facilities, which leave their hopes repeatedly shattered by the incessant strike actions.

Multiple strike actions by major health worker unions over salary arrears and poor working conditions paralysed the health sector. In July 2025, for instance, nurses under the aegis of National Association of Nigeria Nurses and Midwives (NANNM) for the first time in a long while staged a seven-day warning strike over the non-implementation of the approved by the National Council on Establishment (NCE) in 2016; the non-implementation of the National Industrial Arbitration Court (NIC) judgment of January 27, 2012; the upward review of shift allowance; adjustment of uniform allowance; a separate salary structure for nurses, and an increase in core duty allowance among others.

On September 12, 2025, the Nigerian Association of Resident Doctors (NARD) commenced a five-day warning strike over unpaid salary arrears, allowances and other issues affecting their welfare. This later culminated in a total, comprehensive, and indefinite strike from November 1 to 29, 2025, disrupting services in all the public hospitals across the country.

During the industrial action, which lasted almost one month, the NARD presented a 19-point minimum demand that it said must be met by the government. The strike was suspended after a memorandum of understanding was reached with the government negotiating team, with timelines for implementing each demand specified.

Just two weeks into the NARD strike, the Joint Health Sector Unions (JOHESU), which represents non-physician health workers, including laboratory scientists, pharmacists and other allied health professionals, commenced an indefinite nationwide strike on November 14, 2025, over the Federal Government’s failure to implement the adjusted Consolidated Health Salary Structure (CONHESS) and other longstanding welfare demands.

The nationwide strike, which lasted about 84 days, was suspended following a conciliation meeting between the union and the Federal Government. 

According to a communique issued at the end of its expanded National Executive Council emergency hybrid meeting, JOHESU noted that the suspension was to allow for four months of consultation on the High-Level Committee Report on CONHESS Adjustment and the CBA Committee on Allowances. 

For stakeholders, this vicious cycle of industrial action worsens the woes of the already strained health system, which is grappling with a manpower shortage, the mass exodus of the skilled healthcare workforce, infrastructural decay, and chronic underfunding, among others.

The Guardian investigations revealed that, beyond salary and welfare issues, another source of tension in the health sector is interprofessional rivalry, characterised by struggles for superiority, authority, and recognition among different health disciplines.

There has been growing concern among other health workers about the perceived dominance of physicians in virtually all hospital administrative positions, who, according to them, constitute less than five per cent of the health workforce.

Other health workers believe that doctors are favoured in the system over other professionals and have insisted that the government must address the situation by appointing independent, professional administrators to manage hospitals to improve efficiency and reverse the nation’s poor health indices.

While the industrial action by the resident doctors was put on hold following a presidential intervention led by Vice President Kashim Shettima, with the government meeting a substantial number of the 19-point demands, NARD promised to meet by the end of last month to review the situation.

However, the JOHESU strike took a new dimension with the Trade Union Congress of Nigeria (TUC) and the Nigeria Labour Congress (NLC) threatening to commence a nationwide strike if the Federal Government fails to implement the CONMESS within 14 days.

While accusing the Federal Ministry of Health and Social Welfare of deliberately refusing to implement the report of the Technical Committee on CONHESS submitted in 2021 the unions further alleged that the delay amounts to institutional disrespect to health workers and organised labour and consequently vowed that there will be mass protests, picketing of health institutions and government offices, and a nationwide withdrawal of services, if the government fails to implement their demands within 14 days.

But the ministry, in its response, described as untrue the allegations of a deliberate refusal to implement the Technical Committee’s report, adding that there is no discrimination against any category of health workers.

It argued that contrary to these claims, the Federal Government had, since the commencement of the industrial action, held several conciliatory meetings with JOHESU, both at the Federal Ministry of Health and Social Welfare and the Federal Ministry of Labour and Employment, aimed at resolving the dispute amicably.

The health sector shares common characteristics with the education sector, including the multiplicity of trade unions and professional associations, incessant strikes, and the non-implementation of longstanding agreements reached with the government.

While the Minister of Education, Dr Tunji Alausa who was recently the Minister of State for Health and Social Welfare has secured a good deal with the Academic Staff Union of Universities (ASUU) on contentious issues that have lingered since 2009, including 40 per cent increase in salaries and improved pensions /lifelong benefits for retirees, all aimed at resolving issues stemming from the 2009 FGN-ASUU agreement and ending frequent industrial actions in the nation’s public universities, there are concerns about whether the same approach can used by the Minister of Health and Social Welfare, Prof. Muhammad Ali Pate to address once and for all, the frequent strikes in the health sector.

However, health stakeholders believe that, rather than renegotiation, the government should implement the Collective Bargaining Agreement reached with the health workers.

Speaking with The Guardian, NARD President Muhammad Suleiman emphasised that the Collective Bargaining Agreement is the only pathway to resolving the lingering welfare and remuneration issues of resident doctors in Nigeria.

Suleiman stated that “collective bargaining is the only platform that doctors, nurses, pharmacists, and other health workers have for negotiation because everything that has been done, no salary increment, no salary adjustment has happened, everything that has been done is a correction of previous agreements and errors.

Moving forward, if we are going to renegotiate, what is the take-home, what is the welfare, what are the rules that govern remuneration and reward system for everybody in the sector in that collective bargaining?”

“When we finish that collective bargaining, the next thing they will tell us is that it is not in the budget, you have to wait for the budget of next year. So that collective bargaining is even what other health workers, other unions in the health sector, other associations in the private sector are looking for.”

Former President, Pharmaceutical Society of Nigeria (PSN), and the Chairman, Assembly of Healthcare Professional Associations (JOHESU/AHPA), Olumide Akintayo, blamed the vicious cycle of strikes in the health sector on lawlessness on the part of the various appendages of the Federal Government, adding that various government organs sign CBAs and MoUs which are never respected.  

He criticised the leadership structure within the health sector, arguing that the dominance of physician-led appointments in a multidisciplinary sector has undermined effective management.

He said, “The Health Sector has been unlucky in terms of the quality of leadership appointments since about 2007. It is these poor stewardship roles by those in charge that continue to put stakeholders in absolute jeopardy. Health is a multidisciplinary endeavour, not confined to the imposition of a single profession to steer its ship.

“To resolve this crisis, the government must be bold enough to appoint seasoned administrators and professionals with strong corporate management experience to run the entire health value chain, from hospitals to the level of medical directors.”

“ When ministers and CEOs of MDAs in the health sector learn to shun professional protectionism, then we might make progress in alignment with best practices.”

On whether the renegotiation and other strategies deployed by the education minister in handling the protracted Academic Staff Union of Universities (ASUU) crisis, should be used by the health minister to secure a better deal for health workers and ensure lasting peace and industrial harmony in the health sector, Akintola said, “The ASUU saga lasted for about 16 years before a seemingly subsisting agreement was signed.

Also, the Secretary General of NANNM, Thomas Shettima, told The Guardian that to reduce the level of strikes in the health sector, the government must be deliberate in addressing issues that border on the management of public health facilities, adding that if the situation is not addressed, the sector will continue to have issues.

“If you go to hospitals, which are ordinarily made up of so many professionals, you discover that a medical doctor who does not know administration will be the administrative head there. What you have not learned, you are bound to make mistakes, and you are bound to favour yourself.

“So, if you go to, whether it is a federal medical centre or whatever level it is, it is like that, but if you bring in somebody like a hospital administrator who is a non-clinical staff, then all the clinical professionals will now rise to the peak of their own career. So, that one will now serve as the chairman. Even if it is the TMC, the Health Management Committee, then that neutral person will now be the chairman. So, every professional will bring their own issues to the ground…”

Shettima, who categorically stated that there is no need for fresh negotiations, said, “What is the point of the CBA? When you set up a CBA, if you have any product, you have to abide by that product. What I mean by product is the Bargaining Agreement. If you have an agreement with the government, of course, you should honour it, but if you haven’t reached a point of agreement, you resuscitate the CBA.

“Let it continue from where you stopped. I think that is the fundamental thing. If they haven’t finished, they have to activate that, and that is strictly the responsibility of the Federal Ministry of Labour, which is dealing with the responsibility of calling the parties together. That is the Ministry of Health and the JOHESU members.”

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