Healthcare workers’ industrial action in Nigeria: a cross-sectional survey of Nigerian physicians

Abstract

BackgroundThe Nigerian health system has been plagued with numerous healthcare worker strikes (industrial action) at all levels. The purpose of this study is to document physicians’ views on healthcare worker-initiated strike action in Nigeria and represent a follow-on to a previous study where poor leadership and management were cited as the most common cause of strike action by healthcare workers.MethodsA cross-sectional, descriptive study was executed between April and June 2017. We used a self-administered pre-tested structured questionnaire with open-ended questions to allow for better expression of participants’ views. Participants were drawn mainly from the recently concluded West African College of Physicians (WACP)/Royal College of Physicians (RCP) Millennium Development Goal 6 Partnership for African Clinical Training (M-PACT) course. They represented the six geopolitical zones of Nigeria. Data were analysed using SPSS v 23. Simple frequencies were performed, and relevant tables/charts were developed.ResultsA total of 58 physicians (out of 131 participants reached) responded to the study, giving a response rate of 44.3%. 62.1% were males, 67.9% were between the ages of 30 and 39 years, and over 60% of respondents graduated prior to 2010. Poor staff welfare was cited by 16.7% as the commonest cause of strikes in the healthcare system. Other causes cited were salary issues (13.9%), leadership and management (13.9%), poor hospital infrastructure (11.1%), poor guidelines and services (11.1% each) and inter-professional disputes (5.6%). The negative consequences of strikes, the groups who benefit from them and solutions to the strikes were enumerated, including training physicians in leadership skills by 98.2% of respondents.ConclusionPoor staff welfare, salary and leadership/management and governmental inability to implement agreements were the common causes of healthcare worker strikes in this study. These strikes resulted in disruption to service delivery and training programmes, increased morbidity and mortality of patients and loss of confidence in the hospitals and the healthcare professions. The participants recommended that the Federal Government respects agreements made with the management of healthcare institutions, implements the National Health Act and ensures that only leaders and managers who are formally trained are appointed to healthcare management positions.

Perceptions and predictors of organizational justice among healthcare professionals in academic hospitals in South-Eastern Nigeria

“…The moderate level of distributive justice might be due to perception by all health professionals that salaries, promotional opportunities and hospital resources are generally insufficient. Inadequate pay and hospital resources have been reasons for industrial actions in Nigeria [13,[15][16][17]28]. However, our findings that nurses and AHPs had significantly lower perception of distributive justice than doctors validate findings of a previous Nigerian study [11].…”

“…First, pay disparity between doctors and non-doctors were perceived as unfair by non-doctors. Evidence show that unfairness in health sector salaries decreased perception of distributive justice among health professionals [3,11,[13][14][15][16][17][18]. Secondly, doctors seem to have more access to leadership and managerial positions, hospital resources, training opportunity and preferences in work schedules than non-doctors in teaching hospitals.…”

“…Perception of unfairness in salaries decreased perception of distributive justice among healthcare professionals [3,11,[13][14][15][16][17][18][19][20]. In Tanzania, the experience of being by-passed by colleagues with shorter working experience and longer formal training was most dissatisfying for health workers with longer working experience [14].…”

“…Studies indicate that doctors participated more in decision-making than nurses and other health professionals [3,9,[14][15][16][21][22][23]. Australian nurses perceive organizational policies and procedures as being fair [4].…”

“…In Nigeria, evidence of organizational injustice, deriving from studies on industrial actions, inter-professional conflict, and health workforce governance highlight the huge organizational challenges in managing and motivating healthcare professionals for effective performance in Nigeria especially importance of rewards, professional dominance and work climate [13,[15][16][17]28]. Although there are growing concerns about whether rewards and hospital resources are allocated to healthcare professionals equitably and whether such allocation decisions are made according to fair methods and guidelines, studies on perceptions of organizational justice among health workers in Nigeria are scarce [11].…”