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Nigeria marked World Health Day this year under the cloud of a nationwide strike by resident doctors, a development that once again exposes the country’s long‑standing struggles with chronic underfunding, stalled reforms and persistent labour disputes in the health sector.
The Nigerian Association of Resident Doctors (NARD) began an indefinite strike at midnight on April 7, aligning with the global observance themed “Together for Health. Stand with Science.” The action, driven by grievances over unpaid arrears and the suspension of a revised professional allowance structure, threatens to cripple services across public hospitals.
NARD’s Secretary-General, Shuaibu Ibrahim, described the government’s decision to halt the new allowance table as “unfortunate,” warning that the move could plunge the sector into yet another prolonged crisis. The disputed allowances include call duty, rural posting incentives and training support many of which doctors say have remained unpaid for months.
The timing underscores a stark irony: on a day dedicated to strengthening health systems through science and collaboration, Nigeria is grappling with a crisis rooted in unresolved welfare issues and systemic underinvestment.
Funding Crisis at the Heart of the Breakdown
Beyond the immediate labour dispute lies a deeper structural challenge Nigeria’s persistent failure to adequately fund its health system.
Despite signing the Abuja Declaration in 2001, which committed African countries to allocate at least 15 percent of their national budgets to health, Nigeria has never met the target. Instead, allocations have hovered below six percent for years.
Recent budget trends highlight the gap:
YearTotal Health AllocationShare of National Budget2023~N1.17 trillion5–6%2024~N1.33 trillion<6%2025~N2.48 trillion~5.5%2026 (proposed)~N2.48 trillion~4.2%
Experts say these figures fall far short when adjusted for inflation, population growth and Nigeria’s expanding disease burden.
But the bigger problem may be the gap between budgeted funds and actual releases.
A BudgIT official noted that “what is appropriated is not always what is released,” leaving health projects chronically underfunded. In 2025, for instance, only N36 million of the N218 billion allocated for capital projects was released. In 2023, just 17 percent of capital funds were utilised, according to the development Research and Projects Centre (dRPC).
Policies Announced, Policies Unfulfilled
Government initiatives such as the Basic Health Care Provision Fund (BHCPF), free caesarean services and subsidised dialysis programmes are designed to improve access. But implementation remains inconsistent.
A resident doctor at Kubwa General Hospital, Paul Ajasa, stressed that financing determines outcomes:
“You cannot separate health outcomes from health financing. Consistent funding, not announcements, is what ensures policies reach people.”
A former hospital administrator in Abuja added that patients often still pay out‑of‑pocket for consumables, drugs and tests despite “free” programmes.
The Nigerian Medical Association (NMA) echoes this concern, arguing that funding must translate into functional facilities, timely releases and adequate support for health workers.
Patients Bear the Brunt
The consequences of underfunding are most visible at the point of care.
Nigeria’s out‑of‑pocket health expenditure remains above 70 percent, among the highest globally. Many households face difficult choices delay treatment, seek informal care or forgo care entirely.
Across public hospitals:
- Patients often buy basic supplies before treatment
- Essential drugs are frequently unavailable
- Equipment is outdated or non‑functional
- Rural primary health centres remain under‑equipped or abandoned
While the BHCPF has improved access in some states, coverage remains uneven.
A Workforce Under Strain
Nigeria’s human resource crisis continues to deepen. With an estimated doctor‑to‑patient ratio of 1:9,000, far below global standards, the system is stretched thin. Migration of health workers seeking better pay and working conditions abroad has worsened shortages.
Those who remain face overwhelming workloads and stagnant welfare conditions factors that fuel recurring strikes like the current one.
The country’s heavy reliance on donor funding for HIV, tuberculosis and malaria programmes also leaves it vulnerable to external shocks, raising concerns about sustainability.
A World Health Day Reminder
This year’s World Health Day theme “Together for Health. Stand with Science.” calls for systems that are adequately funded, data‑driven and accountable. Stakeholders say Nigeria’s recurring crises show how far the country remains from that ideal.
As resident doctors withdraw their services once again, the strike serves as a stark reminder: without sustained investment, consistent policy implementation and genuine commitment to health worker welfare, Nigeria’s health system will continue to struggle, year after year.