IMPACT OF HEALTH WORKER STRIKES ON PATIENT OUTCOMES: A CASE STUDY OF UNIVERSITY COLLEGE HOSPITAL IBADAN

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Health worker strikes represent one of the most severe disruptions to hospital-based care delivery, posing grave risks to patient safety, health outcomes, and the broader public health system. In sub-Saharan Africa, industrial actions by health care workers have become an increasingly frequent phenomenon, driven by persistent grievances over poor remuneration, inadequate welfare packages, unsafe working conditions, government failure to implement agreed wage structures, and systemic underinvestment in the health sector (Manguele et al., 2024). These strikes are not merely labour disputes; they have far-reaching consequences for morbidity and mortality among patients who depend on public hospitals for critical care services.

Nigeria's public health sector has been particularly vulnerable to recurrent and prolonged health worker strikes. The country has witnessed numerous industrial actions by the Nigerian Association of Resident Doctors (NARD), the Joint Health Sector Unions (JOHESU), and other health professional bodies at national and facility levels. A chronology of recent strikes illustrates the severity of the problem: a significant JOHESU strike disrupted services in 2022–2023; subsequent Memoranda of Understanding signed in June 2023 and October 2024 were not fully implemented, precipitating further strikes in late 2025 that once again crippled tertiary hospital services nationwide (Premium Times, 2025). During such strikes, emergency wards, outpatient clinics, surgical theatres, and specialised units operate at minimal or zero capacity, with resident doctors who constitute the backbone of the hospital workforce withdrawing services entirely.

The University College Hospital (UCH), Ibadan, established in 1957 as Nigeria's first university teaching hospital, is one of the most prominent tertiary health institutions in the country and serves as a referral centre for patients from across the South West geopolitical zone. UCH has not been spared from the devastating effects of health worker strikes. Multiple media and clinical reports document instances of near-total shutdown of clinical services at UCH during strike periods, with patients stranded, surgeries cancelled, emergency units barely functional, and families forced to administer medications to critically ill relatives in the absence of nursing staff (Sahara Reporters, 2026; Peoples Gazette, 2025).

The global evidence base on the impact of health care strikes on patient outcomes documents both protective effects (where the anticipation of strikes leads to elective procedure reduction and hence fewer complications) and harmful effects (through delayed care, denial of emergency services, and disruption of chronic disease management) (Essex et al., 2022). A systematic review and meta-analysis by Essex et al. (2022) found that health care strikes are associated with measurable increases in patient mortality in certain settings, particularly when emergency services are suspended. For Nigeria, however, robust empirical evidence on the quantified impact of health worker strikes on patient outcomes at specific teaching hospitals is lacking. This study addresses this gap through a case study of UCH Ibadan.

1.2 Statement of the Problem

The recurrence and duration of health worker strikes in Nigerian public hospitals have reached crisis proportions, with direct implications for patient safety and outcomes. At UCH Ibadan, industrial actions have resulted in empty wards, closed emergency units, and the near-complete withdrawal of resident doctors, who constitute the majority of the active clinical workforce. Patients with acute conditions including obstetric emergencies, surgical needs, and critical illnesses are among those most severely affected. Yet, despite the visible humanitarian toll of these strikes, systematic analysis of their impact on quantifiable patient outcomes, such as morbidity rates, mortality rates, length of hospital stay, treatment delays, and patient displacement to private facilities, has not been conducted at UCH Ibadan.

This evidence gap has significant consequences. Without empirical data on the patient outcomes impact of strikes, health administrators, policymakers, and labour negotiators lack a shared understanding of the true cost of industrial disputes to patient welfare. This makes it difficult to design effective conflict resolution mechanisms, enforce minimum service provisions during strikes, or build the political will required to address the underlying systemic causes of health worker grievances. This study addresses this problem by systematically examining the impact of documented health worker strikes on patient outcomes at UCH Ibadan.

1.3 Research Questions

This study is guided by the following research questions:

1. What has been the documented pattern and duration of health worker strikes at UCH Ibadan between 2019 and 2024?
2. What is the impact of health worker strikes on patient admission, discharge, and mortality rates at UCH Ibadan?
3. How do health worker strikes affect access to emergency and surgical services at UCH Ibadan?
4. What coping strategies do patients and their families adopt during health worker strike periods at UCH Ibadan?
5. What are the perceptions of health workers and hospital management regarding the impact of strikes on patient outcomes?

1.4 Objectives of the Study

1.4.1 General Objective

The general objective of this study is to examine the impact of health worker strikes on patient outcomes at the University College Hospital, Ibadan.

1.4.2 Specific Objectives

The specific objectives are to:

1. Document the pattern, frequency, and duration of health worker strikes at UCH Ibadan between 2019 and 2024.
2. Assess the impact of health worker strikes on patient admission, discharge, and mortality rates at UCH Ibadan.
3. Evaluate the effect of strikes on access to emergency and surgical services at UCH Ibadan.
4. Identify the coping mechanisms adopted by patients and their families during strike periods at UCH Ibadan.
5. Explore the perspectives of health workers and hospital management on the consequences of strikes for patient outcomes.

1.5 Significance of the Study

This study is significant for multiple reasons. First, it generates much-needed empirical evidence on the patient outcomes impact of health worker strikes in a Nigerian tertiary hospital context, contributing to the global literature on health worker industrial actions and patient safety. Second, the findings will provide hospital management at UCH Ibadan with a data-driven understanding of the most critical service gaps arising during strike periods, informing contingency planning and minimum service provision frameworks. Third, for the Federal Ministry of Health and Ministry of Labour, the study provides evidence that can strengthen the case for timely resolution of health worker grievances and the implementation of binding agreements.

For health worker unions including NARD and JOHESU, the study provides an evidence base for advocating improved terms of service while acknowledging the humanitarian obligations inherent in healthcare work. The study also contributes to the growing body of African health systems research on health worker industrial actions (Manguele et al., 2024), addressing an important literature gap on patient outcomes in high-burden settings. Finally, the findings have implications for health policy on the management of health sector labour relations and the protection of patient rights during industrial disputes.

1.6 Scope of the Study

The study is geographically confined to the University College Hospital, Ibadan, Oyo State. It covers documented health worker strike episodes at UCH from 2019 to 2024, capturing both pre-COVID-19 and post-pandemic periods to enable longitudinal comparison. The study population includes patients admitted during strike and non-strike periods, health workers at UCH, and hospital management staff. Outcome measures of interest include admission rates, discharge outcomes, mortality, access to emergency services, and patient displacement to alternative facilities.

1.7 Limitations of the Study

The case study design limits the generalisability of findings to other Nigerian teaching hospitals or settings outside UCH. Retrospective analysis of hospital records may be constrained by data quality issues, including incomplete documentation of outcomes during strike periods when administrative activities are also disrupted. Attribution of changes in patient outcomes specifically to strike actions, as opposed to other confounding factors such as seasonal disease burden or resource shortages, presents methodological challenges. The study will employ difference-in-differences analysis and triangulation with qualitative evidence to address this limitation.

1.8 Definition of Terms

Health Worker Strike: A collective work stoppage by health care professionals or unions in response to unresolved grievances relating to remuneration, working conditions, or welfare, resulting in partial or complete withdrawal of clinical services.

Patient Outcomes: Measurable health results experienced by patients, including clinical endpoints such as mortality, morbidity, length of stay, treatment completion rates, and patient satisfaction.

Industrial Action: Any collective action taken by workers or their unions to press employment-related demands, including strikes, go-slows, work-to-rule, and mass resignations.

JOHESU: The Joint Health Sector Unions, comprising non-physician health professionals including nurses, pharmacists, physiotherapists, and allied health workers in Nigeria's public health sector.

NARD: The Nigerian Association of Resident Doctors, a professional body representing resident (postgraduate trainee) doctors in Nigerian public hospitals.

Teaching Hospital: A tertiary health institution affiliated with a university, responsible for providing specialist clinical services, medical education, and research.

Minimum Service Provision: A legally or ethically defined level of essential health services that must be maintained even during industrial action to safeguard patient life and safety.

REFERENCES

Essex, R., Weldon, S. M., Thompson, T., Kalocsanyiova, E., McCrone, P., & Deb, S. (2022). The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies. Health Services Research, 57(6), 1218–1234. https://doi.org/10.1111/1475-6773.14022

Essex, R., & Weldon, S. M. (2023). The impact of strike action on healthcare delivery: A scoping review. The International Journal of Health Planning and Management, 38(3), 802–819. https://doi.org/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. https://doi.org/10.3389/fpubh.2024.1209201

Peoples Gazette. (2025, November 24). Wards empty, emergency services shut at UCH Ibadan as health workers' strike enters eighth day. Peoples Gazette. https://gazettengr.com/wards-empty-emergency-services-shut-at-uch-ibadan-as-health-workers-strike-enters-eighth-day/

Premium Times. (2025, November 14). Nigeria's health sector crisis deepens as another union commences strike. Premium Times. https://www.premiumtimesng.com/news/headlines/835512-just-in-nigerias-health-sector-crisis-deepens-as-another-union-commences-strike.html

Sahara Reporters. (2026, February 2). They are letting us die: Patients stranded as Nigerian health workers' strike leaves teaching hospitals, others barely functional. Sahara Reporters. https://saharareporters.com/2026/02/02/they-are-letting-us-die-patients-stranded-nigerian-health-workers-strike-leaves-teaching

FIJ Nigeria. (2025, December 19). Doctors speak up on month-long JOHESU strike silently killing patients nationwide. Foundation for Investigative Journalism. https://fij.ng/article/doctors-speak-up-on-month-long-johesu-strike-silently-killing-patients-nationwide/