BY ABUJAH RACHEAL
As strikes persist and doctors leave in droves, Nigeria’s health system continues to search for a cure.
At 8:30 a.m., the corridors of the National Hospital, Abuja, are already crowded.
Inside, a young resident doctor; who asked not to be named begins another 36-hour shift after her department lost five colleagues to the United Kingdom in 2025.
“I love my patients, but love does not pay rent or refill oxygen cylinders,” she said.
Her exhaustion captures a crisis at the heart of Nigeria’s health system; a workforce stretched to breaking point by migration, poor working conditions, and frequent strikes.
It may be recalled that the Nigerian Association of Resident Doctors (NARD) declared an indefinite strike on Nov. 1.
The action followed the Federal Government’s failure to meet its 19-point demand covering welfare arrears, promotion, and working conditions.
NARD President, Dr Muhammad Suleiman, insists that the strike followed “years of unfulfilled promises”.
He noted that resident doctors endure excessive workloads, unpaid allowances, and unsafe work environments.
With resident doctors forming the backbone of hospital operations, the industrial action threatens to paralyse services nationwide.
For patients, it is yet another familiar nightmare.
“I have been here since morning, and they said no doctor is available, only the consultants,” said Mrs Iyabo Adebisi, whose son was scheduled for surgery at the National Hospital, Abuja.
“Private hospitals are too expensive. Where do ordinary people go?” she asked.
Beyond the strikes lies a deeper challenge; the relentless “Japa” wave.
Thousands of doctors, nurses, and midwives are migrating abroad each year in search of better pay, career advancement, and safer work environments.
According to the World Health Organisation (WHO), there will be a global shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries.
Nigeria’s case, however, is among the most severe.
The WHO recommends one doctor per 1,000 patients, but Nigeria averages one to 3,500; far below the global standard.
By contrast, the United Kingdom has about 3.17 doctors per 1,000, while the United States has 2.6 per 1,000.
As of 2022, only 74,543 registered doctors served Nigeria’s 218 million people, and fewer than 45,000 were actively practising locally.
Many others now work in the UK, US, Canada, and Saudi Arabia, which actively recruit African-trained clinicians with promises of better pay and working conditions.
Furthermore, the situation is far worse in rural and northern states, where doctor-patient ratios expose deep inequities.
Data from the Federal Ministry of Health (2022) show that Jigawa has one doctor to 27,480 patients, Zamfara one to 20,533, Katsina one to 17,151, Bauchi one to 15,490, and Kano one to 12,750.
Gombe has one doctor to 10,670 patients, Benue one to 8,200, while Lagos fares comparatively better at one to 1,200.
These figures highlight the widening gap between urban and rural access.
In many northern communities, hospitals operate without a single resident doctor, leaving midwives and community health officers to manage emergencies.
In such conditions, burnout is inevitable.
Mrs Grace Michael, a community health officer in the Kwali Area Council, FCT, said she is often the only nurse on night duty.
“Sometimes we lose patients, not because we don’t know what to do, but because there’s no one else to help,” she said.
Meanwhile, the government acknowledges the growing crisis.
For instance, Minister of State for Health and Social Welfare, Dr Iziaq Adekunle Salako, said the shortage is both global and local.
“The WHO recommends one doctor to 1,000 patients. In Nigeria today, we are about one to 3,500.
That global shortage fuels migration across borders,” he said during a media briefing in Abuja recently.
According to him, the Federal Government is implementing a two-fold strategy.
The first is to improve the working environment, and the second is to empower hospitals to hire temporary (locum) staff to fill gaps created by retirements and migration.
He disclosed that N31 billions of doctors’ arrears under the 25– 35 per cent award had been paid, with another N12 billion being processed.
In addition, the National Health Workforce Migration Policy, approved in 2024, aims to manage migration through better incentives, rural posting bonuses, and career development opportunities.
The National Health Sector Renewal Initiative also plans to upgrade infrastructure, expand health insurance, and recruit over 20,000 new health workers, while 69,000 frontline staff will undergo retraining to strengthen service delivery.
However, analysts warn that reforms will fail without adequate funding.
Nigeria still allocates less than five per cent of its national budget to health; far below the 15 per cent Abuja Declaration target.
According to public health expert, Dr Lola Mabogunje, “Each trained doctor who leaves represents an investment loss of millions of naira in education and training.
“Without retention measures, we are subsidising other countries’ health systems”.
Consequently, the health sector continues to lose both financial and human capital.
Albeit a 52 per cent drop in medical tourism spending between 2023 and 2025 due to foreign exchange constraints, Nigerians still spend over one billion dollars annually on treatment abroad.
Health economist, Maimuna Abdullahi, of the African Health Budget Network (AHBN), said the practice undermines trust.
“When leaders seek care abroad, it tells citizens that local hospitals are not good enough,” she said.
Beyond this, experts insist that improved transparency, timely payment of wages, and continuous engagement with unions are vital to breaking the cycle of strikes and migration.
International partnerships could also help, for instance, through bilateral training exchanges that ensure both Nigeria and host countries benefit from migration flows.
Public health analyst, Dr Tunde Ajayi, summed up the moral dimension saying, “Fixing workforce retention is not just a policy issue; it’s a moral one.
“We cannot keep losing our best brains while citizens die from preventable diseases”.
Back at the National Hospital, the young doctor prepares for her next round.
She remains torn between staying and joining colleagues abroad.
“If we had better conditions, many of us would not leave. We just want to work, to heal, and to live,” she stated
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