As Nigeria’s healthcare system teeters on the brink of collapse, the Nigerian Association of Resident Doctors (NARD) has raised the alarm over the plight of house officers – junior doctors who remain unpaid but face gruelling shifts with no relief in sight.

The situation, they say, is a direct consequence of years of neglect that threaten not just the future of the doctors but the foundation of Nigeria’s healthcare.

Also, the Nigeria Union of Allied Health Professionals (NUAHP) lamented the delay in implementing the Consolidated Health Salary Structure (CONHESS) adjustment for members of the union and other health workers.

NARD expressed concern over the continued neglect of house officers in the country’s healthcare system, noting that many of them remained unpaid despite their crucial role on the frontlines of patient care.

In a recent statement shared via the association’s official X page, NARD described house officers as the first resident doctors, typically the first on call, filled with energy and hope, yet left to endure long shifts without proper meals or compensation. The association criticised the ongoing failure to pay the junior doctors as unacceptable.

The statement was accompanied by a chart revealing that 18,949 doctors left Nigeria over the last 20 years, citing poor welfare and a failing health system as key drivers of the migration.

Data from the Federal Ministry of Health and Social Welfare showed sharp increases in migration during specific years: 2007 (3,542), 2021 (2,607), 2022 (2,900), and 2024 (3,974), the highest in the two-decade span.

These figures indicate an escalating crisis that has left many healthcare professionals disillusioned. With the country’s doctor-to-patient ratio far below global standards, the system is on the verge of collapse due to an alarming trend of migration, compounded by substandard infrastructure and dismal working conditions.

Speaking to The Guardian, NARD President, Dr Osundara Zenith, reiterated the gravity of the situation, noting that Nigeria’s doctor-to-patient ratio was critically low. While global standards recommend one doctor per 600 patients, Zenith said a Nigerian doctor “often serves more than 1,000 individuals”.

He noted that many resident and consultant doctors were fleeing the country in search of better working conditions abroad. “We have a shortage of doctors, and the few that are here are overburdened,” he said, adding that some doctors were forced to see up to 10,000 patients, resulting in burnout and diminished care quality.

Zenith estimated the number of resident doctors in Nigeria to be between 6,000 and 8,000, a figure he described as grossly insufficient to meet the nation’s growing healthcare demands. He urged the government to implement immediate reforms to improve retention and attract more doctors to the public health system.

Similarly, the President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Prof Aminu Mohammad, discussed the critical shortage of consultants and its implications for healthcare delivery. He noted that while the global healthcare sector is facing a workforce shortage, Nigeria’s challenges were compounded by local economic issues and currency devaluation.

President of the Academy of Medicine Specialties of Nigeria (AMSN), Prof Oladapo Ashiru, underscored the competitive nature of the global medical profession. He said many Nigerian doctors were attracted to countries offering better salaries and working conditions, such as the United States, the United Kingdom and Germany.

He urged the Federal Government to study and adopt retention strategies from countries like India, Egypt, South Africa and Australia, warning that “unless decisive steps are taken”, the country’s healthcare system would face an even deeper workforce crisis.

NUAHP expressed dismay that since 2014, when the agitation started after the Federal Government violated the collective bargaining agreement establishing the two salary structures in the health sector by adjusting the Consolidated Medical Salary Structure (CONMESS) for medical practitioners without replicating the same to the CONHESS for other health workers.

This was disclosed in a communiqué issued on Tuesday at the end of the union’s National Executive Council (NEC) meeting in Jos, Plateau State.

The communiqué was signed by the union’s President. Kamal Ibrahim, and the General Secretary, Martin Egbanubi, noted that despite the signing of a Memorandum of Understanding (MoU) between government and the Joint Health Sector Unions (JOHESU) on October 29, 2024, after a conciliation meeting that led to the suspension of JOHESU’s nationwide strike; the government is yet to fulfil its obligation contained in the MoU.

The union was also worried about the seven months’ arrears (June to December 2023) of the 25 per cent and 35 per cent review of CONHESS, despite being captured in the 2024 budget and the 2025 budget.