FACTSHEET Why do Nigeria’s doctors feel unloved?

Doctors in Nigeria have recently ended a strike. But what are the key issues that inform the regularity of work boycotts in the country’s public healthcare sector, causing many to leave?

If you go to a teaching or federal public hospital in Nigeria your first contact will likely be a resident doctor, a category of physicians training to become specialists.

These doctors have suspended their latest strike – a debilitating 10-day nationwide boycott that started on 4 September – but warned this was temporary unless their terms are met.

Suspension means that at any point in time the strike can be resumed after a review of the terms and conditions reached by both parties,” Dr Ayodele Renner, a member of the doctors’ union told Africa Check.

The National Association of Resident Doctors, had a shortlist of six demands when they started their walk-out, that:

  • The government pays salary arrears accrued in 2016 and the first five months of 2017
  • The authorities rectify this shortfall in salary from August 2017
  • Entry pay for graduating doctors known as house officers be enforced
  • Promotion of resident doctors be addressed
  • All doctors be paid directly from the central government payroll, and;
  • Solve the non-deduction and remittance of pension to their retirement savings account

The medics have downed tools before, notably in 2014 when their strike coincided with the Ebola virus outbreak. In response the federal government suspended the residency programme in its hospitals, effectively sacking 16,000 resident doctors. They were reinstated two weeks later.

Other medical workers have also announced intentions to strike. Nigeria will continue to see unrest among its healthcare workers because governments do not honour agreements, Dr Osahon Enabulele, former president of the Nigeria Medical Association, the country’s largest healthcare association, told Africa Check.

“Our president went to London to procure health services and told the world that he was prepared to listen to his doctors in London. [But] do they listen to their doctors in Nigeria? If [they do], why allow these doctors to even embark on strike in the first instance without solving their problem?” asked Enabulele, who now heads the Commonwealth Medical Association.

This factsheet explores the recurrent grievances of Nigeria’s doctors.

Pay – how much do they take home?

As salaries and allowances are a regular feature in disputes, how much do they earn? The remuneration of federal medical workers and dentists is stipulated in the Consolidated Medical Salary Scale.

An entry level doctor earns an annual basic salary of about N1.3 million ($4,267 at the official central bank rate), rising to N4.2 million for the highest grade.       

Doctors’ Remuneration
(entry level)
(Naira) US$
Basic salary 1,305,688 4,267
Non- clinical allowance 541, 080 1,768
Teaching allowance 112,454 368
Rural posting allowance 112,454 368
Hazard allowance 60,000 196
Total 2,131,676 6,771

Note: They also get N1,503 as call duty allowance (US$5 per unit of call.) Conversion based on the Central Bank of Nigeria rate of N305.95/US$.

In contrast, a federal lawmaker takes home between US$166,739 and US$184,961 annually, enough to pay at least 40 entry level doctors.

Nurses, midwives and other health workers under the Consolidated Health Salary Structure earn significantly lower than doctors.

For regional comparison, a June 2017 deal signed by Kenyan doctors would see the lowest paid take home a gross monthly pay of KSh212,989 (US$2,000). In South Africa, a full time intern earns US$2,760 monthly.

What is their work environment like?

Doctors told Africa Check that successive governments have only paid lip service to fixing the country’s ailing health sector.

“The implication is worsening health [indicator] statistics, people will die, people will suffer and seek healthcare [in places] where they shouldn’t,” Lagos-based physician Dr Fadahunsi Fajuyitan told Africa Check.

A previous Africa Check report found that Nigeria’s spending on health as a share of its gross domestic product is less than that of Angola, Ethiopia and South Sudan.

Nigeria's President Muhammadu Buhari arrives at the airport in Abuja after health checks in a London hospital, on 19 June 2016. He has also been treated in 2017. Photo: AFP/ Sunday Aghaeze
Nigeria’s President Muhammadu Buhari arrives at the airport in Abuja after health checks in a London hospital on 19 June 2016. He has also been treated in 2017. Photo: AFP/ Sunday Aghaeze

Fixing the healthcare system was a core campaign promise by president Muhammadu Buhari, who took office in 2015. He promised that “no Nigerian will have a reason to go outside of the country for medical treatment”. But this year he spent more than 150 days away on medical leave in the United Kingdom, on treatment for an undisclosed ailment.

Fajuyitan, who has practised for nine years, said a key step to improving the creaking system would be to implement the National Health Act. Enacted in 2014, it stipulates regulation, development and management of health systems and sets standards for rendering health services in Nigeria.

“Implementing this health act will go a long way in terms of [provisions for] funding, health insurance, remuneration, training and others. It is up to the government to have the political will to implement [it],” he added.

The government is developing a new national health policy to address the country’s major challenges which it says include a weak and unresponsive healthcare system.

Are the doctors overworked?

To alleviate the latest strike, the government said it would hire stopgap doctors. But there aren’t enough to go around in the first place.

In 2013, Nigeria had 65,759 registered doctors,  according to the 2016 National Health Policy. This is a doctor-patient ratio of about 1:2,660, or about 7 times more than the UK or the US for the same year, according to World Health Organisation data. (Note: While Nigeria’s  population figures are disputed, the National Bureau of Statistics in 2013 estimated it at 175 million.)  

The country needs more than 250,000 doctors in the next 10 to 15 years to meet its staffing shortfall, Enabulele said.

Between 2010 and 2015 there has been a 29% increase in the number of students admitted to study medicine, from 15,974 to 20,583, according to matriculation data from the Joint Admissions and Matriculation Board and the country’s statistics agency.

Are more Nigerian doctors thus seeking greener pastures?

A recent survey of 705 doctors found that 9 in 10 Nigerian doctors of all levels are seeking to work abroad. Among other reasons, they cited better facilities and work environment, higher pay and career progression as why they would leave.

Twenty per cent of the respondents said they know between 16 to 30 colleagues who had emigrated from Nigeria in the last 2 years. Nearly nine in 10 said they believed the government was not too concerned with resolving the issues doctors face.

Where are they flocking to?

The top destinations for exiting Nigerian doctors are the United Kingdom, United States and Canada. If they wish to remain in the region, most head to South Africa. A UK register of doctors last updated on 3 July 2017 shows Nigeria is the fourth country of qualification of the over 261,000 general and medical practitioners in that country. About 4,765 of them earned their degrees from Nigeria.

“These are doctors that were trained in Nigeria for the Nigerian people [but] who unfortunately will not be available to work for the Nigerian people,” said Fajuyitan.

Said Enabuele: “Unless and until the Nigerian government is responsive to the push and pull factors which moderate the migration of health professionals particularly medical doctors, we will continue to see-saw without advancing.”

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