Before the next doctor leaves

Guest Columnist By Egena Sunday Ode

This month Nigeria’s hospitals went quiet in two different ways.  In Lagos, doctors under the Medical Guild walked out for three days in early July. Their complaint was direct: “illegal” deductions announced for July salaries, 12 months of CONMESS arrears owed to honorary consultants at Lagos State University Teaching Hospital (LASUTH), and agreements signed but not honored. For 72 hours, outpatient clinics in the state’s general hospitals were locked. Patients who had queued since dawn were told to come back.

Three weeks earlier, in June, the pressure was already building. House officers in at least eight federal hospitals, including UATH Abuja, UCTH Calabar and FMC Umuahia, began a nationwide strike on June 24 over two months of unpaid salaries. Around the same time, the NMA Abuja chapter issued a strike notice at the National Hospital over the disengagement of three consultants. Expectedly, outpatient units slowed and  surgeries were postponed.

We have been here before. It’s a familiar road. During the last administration of the late President Muhammadu Buhari, the “japa” syndrome hit its peak. Thousands of doctors and nurses left in a single year. The wards thinned out and the waiting lines got longer. When the public outcry became too loud to ignore, the then Minister of Labour and Productivity, Dr Chris Ngige, offered a response that many health workers still quote with anger today. Nigeria, he said, had “more than enough” doctors and nurses. That we could afford to lose some.

What a wrong diagnosis. The problem was never the number of people trained. The problem was how many were willing to stay. And the answer came in boarding passes.

It was also public knowledge that the former First Lady, Aisha Buhari, had a public running battle with the then Chief Medical Director of the State House Medical Centre. Her complaint was simple and damning: persistent shortage of consumables. No syringes. No gloves. No basic drugs. Meanwhile, the hospital management was busy prioritizing physical expansion, new buildings, new wings. She asked the question patients have been asking for years: what is the point of a bigger hospital if there is nothing inside it to treat you?

That was Buhari’s era. Now is Tinubu’s. But the symptoms not the same?

A health system frays not with a press statement announcing its death, but with a series of small absences that add up. The doctor is there, but the nurse is not. The nurse is there, but the drugs are not. The equipment is there, but the person trained to use it has booked a flight.

What they asking for are constant demands that have not been met. The list has not changed in years, only the urgency has. Nurses want a review of shift, call duty and uniform allowances that have not moved in a decade. They want a salary structure of their own, the way doctors have CONMESS. They want mass recruitment because one nurse is now doing the work of three. They want a retention allowance, because the alternative to staying is leaving. They also want the June 27 circular from the National Salaries and Wages Commission reversed. Nurses say the circular cut allowances and failed to create a separate salary structure for them.

Similarly, doctors want their money back and a promise that deductions will not happen again without notice. House officers want arrears cleared. The NMA wants reinstated colleagues. None of these demands are new. What is new is how little time is left before the people making them decide they are done asking.

The numbers speak clearly to the issue. In 2024 alone, 20,966 Nigerian health workers left the country for jobs abroad. That is not a trickle. That is entire departments. Nurses and midwives deliver between 60 and 70 percent of hospital services in Nigeria, according to their own association. When they go, primary care collapses first. When doctors go, surgeries are postponed and specialist clinics close.

And yet, last week in Abuja, there was a different conversation happening. President Bola Tinubu met with a delegation of Nigerian doctors in the diaspora at the Aso Rock Presidential Villa. The room was full of people who left, built careers in the UK, the US, Canada and Saudi Arabia, and came back for a meeting.

The President’s pitch was simple: come home, or at least, come and help. He spoke about incentives, about opportunities in the new health reforms, about making Nigeria a place where expertise is valued. The diaspora doctors spoke about why they left, and what it would take to return, even part-time. Better equipment. Functional hospitals. Protection from assault. Pay that reflects the training. A system that does not punish you for doing the right thing.

It was a good meeting. Photos were taken. Statements were released about “brain gain” and “collaboration.” But meetings do not run wards. Policies do. And right now, the policy on the ground is pushing people in the opposite direction.

You cannot invite doctors back from Houston while announcing deductions in Ikeja without warning. You cannot talk about retention allowances in Aso Rock while nurses in Dutse, Birnin Kebbi and Enugu are buying their own gloves. You cannot celebrate diaspora expertise on Monday and ignore a strike notice on Tuesday. People watch what you do, not just what you say.

This is not to dismiss the meeting. Nigeria needs its diaspora doctors. Telemedicine, training partnerships, short-term specialist visits, research collaborations — all of that can work. Countries like Ghana and India have built models around it. But diaspora engagement cannot be a substitute for fixing the hospitals that are here today. It cannot be the plan while the plan for those still on payroll continues to fail.

The patient experience over the last six weeks showed us what failure looks like. A pregnant woman in labor at a federal hospital met a doctor who was doing the job of a nurse, a cleaner, and a pharmacist. A diabetic man in Lagos had his appointment cancelled twice. In both cases, the staff were apologetic. They were also exhausted. You cannot shame people into staying in a job that is breaking them.

Government’s response, as usual, was to call for dialogue. Committees were set up. Patience was requested. But patience does not treat hypertension. Dialogue does not start an IV. A circular does not recruit a nurse.

We keep funding hospitals and forgetting that hospitals are people. Buildings do not treat patients. People do. And those people are making calculations every day. Can I pay my rent with this salary? Can I work a 36-hour shift and still be safe? If my child is sick, can I afford the same hospital I work in? If the answer is no, they leave. Sometimes to a private hospital in Lagos, Kano or elsewhere in Nigeria. More often to London, Manchester, or Toronto.

The argument is not that health workers should not protest. They should. The argument is that we should not force them to. The best way to avoid strikes is to remove the reasons for them. Pay what you owe. Hire more hands. Respect agreements. Protect staff from patients and from the system itself.

What happened at Aso Rock last week matters because it shows the government knows there is a crisis and is looking for solutions. But the solution cannot start and end with those who left. It has to start with those who stayed. The nurse who showed up during the June disruptions. The doctor who covered two departments. The intern who has not been paid in two months but still came to work.

If we lose them, there will be no one left for the diaspora doctors to collaborate with. You cannot do telemedicine into an empty ward. You cannot mentor residents who do not exist.

So the question before us is not whether the meeting in Abuja was useful. It was. The question is what happens this week, and next month. Will the salary deductions be reversed? Will the allowances be reviewed? Will recruitment start? Will the nurse in Port Harcourt or Kaduna see a reason to stay?

Because before the next doctor leaves, a patient will need them. Before the next nurse resigns, a child will need an injection. Before the next flight takes off from MMIA, someone in a government hospital will be told, “come back next week.”

We are running out of next weeks.

If we are serious about “brain gain,” we have to start with “brain retention.” That means treating the people in our hospitals as essential, not as line items to be deducted. It means matching the tone of Aso Rock with the reality of the wards. And it means not repeating the mistakes of the last administration — dismissing the exodus, and building buildings while the consumables run out.

Otherwise, we will keep having meetings about the people who left, while the people who stayed keep walking out. And the hospital will keep getting emptier.