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Health Workers’ Strike and Healthcare Delivery in Nigeria: A Conceptual Examination of System Disruption in a Resource-Constrained Setting

DOI https://doi.org/10.55640/corr-v04i02-04
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Leonard Nnamdi Meruo 1 ORCID iD , Paul Mbaya 1 , Kennedy Oberhiri Obohwemu 1 ORCID iD , Gordon Mabengban Yakpir 1 , Celestine Emeka Ekwuluo 1 ORCID iD , Kenneth Oshiokhayamhe Iyevhobu 1 ORCID iD , Daniel Ikechukwu Oseji 1 ORCID iD , Efe Clement Abel 1 ORCID iD , Oluwafemi Emmanuel Ooju 1 ORCID iD , Eddy Eidenehi Esezobor 1 ORCID iD , Solomon Atuman 1 ORCID iD , Chisom Lucky Emeka 1 ORCID iD , Jennifer Adaeze Chukwu 1 ORCID iD , Eke Desmond Onyebuchukwu 1 ,
4 MHPM, Department of Oral Diagnosis and Dental Public Health, D’ Dentist Place Dental Clinic, Owerri, Nigeria; Department of Oral Pathology, D’ Dentist Place Dental Clinic, Owerri, Nigeria; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 PhD, Department of Public Administration, Faculty of Management Sciences, University of Maiduguri, Nigeria.
4 PhD, Faculty of Health, Wellbeing & Social Care, Oxford Brookes University, GBS Partnership, Birmingham Campus, United Kingdom; and PENKUP Research Institute, Birmingham, United Kingdom.
4 PhD, Faculty of Health, Wellbeing & Social Care, Oxford Brookes University, GBS Partnership, Birmingham Campus, United Kingdom; and PENKUP Research Institute, Birmingham, United Kingdom.
4 MPH, Family Health International, Ukraine; and PENKUP Research Institute, Birmingham, United Kingdom; Department of Multidisciplinary Studies & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 MPH, Department of Medical Laboratory Science, Faculty of Applied Health Science, Edo State University, Iyamho, Edo State, Nigeria; Department of Medical Microbiology, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria; and Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 FWACS, Department of Ophthalmology, Federal Teaching Hospital, Lokoja, Nigeria; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 MPH, Clinical Services Department, Medical Research Council Unit, The Gambia At London School of Hygiene and Tropical Medicine; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 MSc, World Health Organisation, Abuja, Nigeria; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 PhD, Department Department of Management Studies, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 MPH, Family Health International (FHI) 360, Durham, North Carolina, USA; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 Vaccine Preventable Diseases Unit/Health Promotion, Disease Prevention and Control Cluster, World Health Organisation Country Office, Abuja, Nigeria; and Department of Interdisciplinary Research & Statistics, PENKUP Research Institute, Birmingham, United Kingdom.
4 World Health Organization, United Nations House, Abuja, Nigeria; and Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom
4 MSc, Capitol Hill Clinic, Warri, Delta State, Nigeria; and Department of Interdisciplinary Studies and Statistics, PENKUP Research Institute, Birmingham, United Kingdom.

Abstract

Health workers’ strike remains a recurrent feature of healthcare systems in many low- and middle-income countries, with significant implications for service delivery and population health. This paper examines the systemic impact of strike action on healthcare delivery within a resource-constrained setting, drawing on evidence from the wider research conducted in selected health facilities in Maiduguri, Nigeria. The study adopts a cross-sectional design, integrating primary data from healthcare workers with secondary insights from institutional records to explore disruption across five key domains: morbidity and mortality, out-of-pocket expenditure, private hospital patronage, laboratory and diagnostic services, and medical tourism.

The findings indicate that strike action generates widespread disruption across the health system. Access to care is reduced, contributing to delayed treatment and perceived increases in disease severity and mortality. Financial burden intensifies as patients shift towards private providers, resulting in higher out-of-pocket expenditure in a context where health insurance coverage remains limited. Private healthcare facilities experience substantial increases in patient turnout, reflecting a redistribution of demand rather than an expansion of system capacity. Diagnostic services are constrained, with reliance on basic investigations and reduced access to advanced imaging, thereby affecting clinical decision-making. Medical tourism is perceived to be rising, although it appears to be driven by broader system challenges rather than strike alone.

The study also highlights critical weaknesses in health information systems, particularly the absence of reliable morbidity and mortality data during strike periods. This limitation constrains effective evaluation and policy response, underscoring the importance of strengthening data governance within the health sector.

The paper argues that health workers’ strike should be understood as a system-level stressor that exposes underlying structural deficiencies, including inadequate financing, weak governance, and limited workforce coordination. Addressing these challenges requires sustained investment in health system resilience, alongside mechanisms that safeguard essential services during periods of industrial action. The findings contribute to ongoing debates on health system stability in resource-constrained settings and emphasise the need for integrated policy responses that balance workforce welfare with the continuity of patient care.

Keywords

Health workers’ strike, healthcare delivery, out-of-pocket expenditure, private hospital patronage, laboratory and diagnostic services

References

📄 AbouZahr, C., & Boerma, T. (2005). Health information systems: The foundations of public health. Bulletin of the World Health Organization, 83(8), 578–583.
📄 Aregbeshola, B. S., & Khan, S. M. (2018). Out-of-pocket payments, catastrophic health expenditure and poverty among households in Nigeria. International Journal of Health Policy and Management, 7(9), 798–806. https://doi.org/10.15171/ijhpm.2018.19
📄 Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2020). Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS Medicine, 17(6), e1001244. https://doi.org/10.1371/journal.pmed.1001244
📄 Buabeng-Baidoo, B., & Olivier, J. (2024). Public–Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study. Health Policy and Planning, 39(5), 469-485.
📄 Chima, S. C. (2013). Global medicine: Is it ethical or morally justifiable for doctors and other health workers to go on strike? BMC Medical Ethics, 14(Suppl 1), S5. https://doi.org/10.1186/1472-6939-14-S1-S5
📄 Craveiro, I., Choudhury, P. K., de OLiveira, A. P. C., Pereira, A., Fronteira, I., Chança, R., ... & Ferrinho, P. (2024). Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review. Human Resources for Health, 22(1), 47.
📄 Craveiro, I., Choudhury, P.K., de OLiveira, A.P.C. et al. Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review. Hum Resour Health 22, 47 (2024). https://doi.org/10.1186/s12960-024-00923-y
📄 Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
📄 Essex, R., & Weldon, S. M. (2022). The justification for strike action in healthcare: a systematic critical interpretive synthesis. Nursing Ethics, 29(5), 1152-1173.
📄 Essex, R., S. Ahmed, H. Elliott, D. Lakika, L. Mackenzie, & S. M. Weldon, (2022). The impact of strike action on healthcare delivery: a scoping review. Int J Health Plann Mgmt. 2022;1-29. https://doi.org/10.1002/hpm.3610
📄 Essex, R., S. Ahmed, H. Elliott, D. Lakika, L. Mackenzie, & S. M. Weldon, (2023). The impact of strike action on healthcare delivery: A scoping review. Int J Health Plann Manage. 2023 May;38(3):599-627. doi: 10.1002/hpm.3610.
📄 Manguele, A. L. J., Sidat, M., Ferrinho, P., Cabral, A. J. R., & Craveiro, I. (2024). Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review. Frontiers in public health, 12, 1209201.
📄 Manguele, A. L. J., Sidat, M., Ferrinho, P., Cabral, A. J. R., & Craveiro, I. (2024). Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review. Frontiers in public health, 12, 1209201.
📄 NHS England, (2025). NHS publishes strike impact data following a record June for treatments. England.nhs.uk. Available at: https://www.england.nhs.uk/2025/08/nhs-publishes-strike-impact-data-following-a-record-june-for-treatments/, (Accessed: 21 October 2025)
📄 Ogunyemi, A. O., Balogun, M. R., Ojo, A. E., Welch, S. B., Akeju, D. O., Onasanya, O. O., ... & Hirschhorn, L. R. (2025). Factors influencing primary health care service provision to older adults in lagos, nigeria: understanding the experiences of the demand population. BMC Public Health, 25(1), 3016.
📄 Okunlola, K. A., Oreofe, I., Ohaeri, B., & Babarimisa, O. (2025). Challenges facing primary health care services utilization and possible solutions. Euro Global Contemporary Studies Journal (EGCSJ), 5(2), 1-12.
📄 Oleribe, O. O., Momoh, J., Uzochukwu, B. S. C., Mbofana, F., Adebiyi, A., Barbera, T., Williams, R., & Taylor-Robinson, S. D. (2019). Identifying key challenges facing healthcare systems in Africa and potential solutions. International Journal of General Medicine, 12, 395–403. https://doi.org/10.2147/IJGM.S223882
📄 Russo, G., Xu, L., McIsaac, M., Matsika-Claquin, M.D., Dhillon, I., McPake, B. and Campbell, J. (2019). Health workers’ strikes in low-income countries: the available evidence. Bulletin of the World Health Organization, 97(7), pp.460–467H. Doi: https://doi.org/10.2471/blt.18.225755.
📄 Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–264. https://doi.org/10.4103/0019-5154.182410
📄 Stoye, G. and M. Warner, (2023) The effects of doctor strikes on patient outcomes: evidence from the English NHS. Journal of Economic Behavior & Organization 212 (2023): 689-707.
📄 Tinimoye, M. (2025). Assessing the Factors Contributing to Quality of Primary Healthcare Service Delivery in Nigeria: A Systematic Review. Port Harcourt Journal of Public Health, 1(1).
📄 Usar, I. J., Akosu, J. I., & Okoye, C. (2022). Recurrent public health care sector strikes in Nigeria: understanding the causes and taming the tide. British Journal of Healthcare and Medical Research-Vol, 9(6).
📄 World Health Organization, (2020). State of the world’s nursing 2020: Investing in education, jobs and leadership. WHO. Available at: https://www.who.int/publications/i/item/9789240003279, (Accessed: 04 November 2025)
📄 World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053

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