The planned three-day warning strike by Nigeria’s medical lecturers is more than another dispute over unpaid allowances.
As 14 of the 17 branches of the Nigerian Association of Medical and Dental Academics, NAMDA, back industrial action beginning next week, the dispute is exposing a contradiction at the centre of Nigeria’s response to the “Japa” crisis: the country wants to train more doctors at the same time as it struggles to retain the medical academics who train them.
NAMDA says the Federal Government has failed to conclude negotiations on the conditions of service of medical lecturers, formally document their payment under the Consolidated Medical Salary Structure, CONMESS, and settle several outstanding allowances, including MCATA, Earned Academic Allowance, Excess Workload Allowance and Professorial Allowance.
But the immediate dispute is only the latest manifestation of a problem that has been building for years.
The central question is no longer simply why are Nigerian doctors leaving?
It is increasingly becoming:
Who will train the doctors Nigeria is trying to produce to replace them?
The problem behind the strike
Nigeria’s doctor shortage has encouraged policymakers to focus on increasing the number of doctors entering the profession.
That sounds straightforward: if migration reduces the country’s medical workforce, increase the number of doctors being trained.
But medical education has a critical constraint.
Doctors cannot be mass-produced without medical academics.
Every additional medical student requires lecturers, consultants, clinical supervisors, laboratories, teaching hospitals and postgraduate trainers.
A senior medical lecturer may simultaneously be responsible for teaching undergraduate students, supervising postgraduate doctors, providing clinical services and conducting research.
When that person leaves Nigeria, the country does not lose only one doctor.
It loses part of the machinery required to produce the next generation.
That is why NAMDA’s warning that government cannot respond to doctor migration simply by increasing the production of doctors is significant. The association has argued that the welfare of the lecturers responsible for training those doctors cannot be ignored.
How Nigeria got here
The problem begins with the economics of medical migration.
Nigeria spends years developing doctors and specialists whose skills are internationally valuable.
A doctor who completes medical school, residency and specialist training can potentially command a much higher income abroad, while also gaining access to better-equipped hospitals, stronger research infrastructure and clearer professional opportunities.
For an individual doctor, leaving can therefore be a rational economic decision.
For Nigeria, however, it creates a peculiar form of human-capital leakage.
The country bears much of the cost of training the professional.
Another country eventually captures much of the professional’s productive value.
The problem becomes more severe when the people leaving are medical academics.
Losing a newly qualified doctor reduces the number of clinicians available to treat patients.
Losing an experienced lecturer can reduce both clinical capacity and the country’s ability to train future doctors.
That creates a multiplier effect.
More medical schools will not automatically solve it
Nigeria can expand admission quotas, establish new medical programmes and increase the number of graduates.
But the quality and capacity of those programmes depend on people.
A medical school cannot simply recruit thousands of students without recruiting enough qualified academics.
Nor can an institution indefinitely increase workloads for the lecturers who remain.
That is why the dispute over Excess Workload Allowance is particularly important.
If the government wants medical schools to train more doctors, it must also recognise the additional teaching burden created by that expansion.
Otherwise, the policy designed to solve the doctor shortage can contribute to the lecturer shortage.
The immediate issue is money — but money is not the whole problem
NAMDA’s demands include several payments that directly affect the earnings of medical academics.
The association says the Federal Government has failed to formally document the payment of medical lecturers under CONMESS and has not paid several academic and professional allowances.
There is also evidence that the problem is not simply one of government refusing to recognise the need for better pay.
In August, NAMDA’s UNILAG branch said an agreement reached in February 2026 still required official circulars from the National Salaries, Incomes and Wages Commission before universities could implement the revised arrangements. Without the circular, the lecturers argued, university authorities were reluctant to release the funds because of public-spending rules.
That distinction matters.
Nigeria’s problem can therefore be both fiscal and administrative.
Government may approve an arrangement.
An agency may need to issue a circular.
A university may then need formal authority to implement it.
A payroll system may need to process it.
By the time the process reaches the worker, months can have passed.
The result is predictable: an agreement becomes another grievance.
Why has government not simply paid?
Because a permanent solution costs more than settling a strike.
This is one of the central difficulties facing Abuja.
Paying outstanding allowances can be treated as an arrears problem.
But increasing salaries, improving specialist allowances and funding retention packages creates a permanent recurring expenditure.
Once one group receives a substantial increase, other health professionals can reasonably demand similar treatment.
University lecturers may demand it.
Other public-sector professionals may demand it.
The government therefore faces the risk of turning one wage dispute into a broader public-sector compensation problem.
That does not mean the government has no options.
It means it needs to move away from an indiscriminate salary approach.
What Nigeria could do instead
The most effective response may be a targeted medical academic retention strategy.
Rather than simply increasing salaries for everyone, government could identify scarce medical specialties and academic positions and attach additional incentives to them.
Those incentives could include:
- specialist retention allowances;
- housing support;
- research grants;
- accelerated promotion;
- funded postgraduate training;
- professional development;
- improved pension arrangements;
- additional compensation for excessive teaching and clinical workloads.
That would allow Nigeria to compete more intelligently for scarce skills without necessarily triggering an across-the-board public-sector wage explosion.
Fix the hospitals, not just the payslips
Money alone will not stop medical migration.
A specialist who has spent years training in a highly technical field also needs the equipment and infrastructure required to practise that specialty.
A doctor may earn more but still become frustrated if diagnostic equipment is unavailable, operating theatres are poorly equipped, research funding is scarce and hospitals lack sufficient support staff.
Nigeria therefore needs to treat medical infrastructure and medical human capital as one policy problem.
A modern teaching hospital without enough specialists is an underutilised asset.
A medical school without enough lecturers is an underutilised training facility.
A research centre without researchers is little more than infrastructure.
Nigeria also has an unusual advantage: thousands of Nigerian-trained health professionals are already working in foreign healthcare systems.
The government has begun using diaspora medical professionals through temporary interventions involving specialist surgeries, consultations and training.
But the bigger opportunity is to move beyond short-term medical missions.
Nigeria could offer diaspora doctors and academics joint appointments, research partnerships, specialist positions, housing incentives and other mechanisms that allow them to maintain international careers while contributing substantially to Nigerian institutions.
The goal should not simply be to persuade doctors to “come home”.
It should be to make coming home professionally viable.
Why the government may still struggle to act
The difficulty is that the problem crosses too many government institutions.
Medical lecturers operate at the intersection of universities, teaching hospitals, the Federal Ministry of Health, the Ministry of Education, labour authorities, salary commissions, budget officials and payroll agencies.
A solution therefore requires coordination across institutions that often have different mandates.
That helps explain why seemingly straightforward issues can remain unresolved for months.
There is also a political incentive to postpone difficult decisions.
A government can survive another negotiation.
It can announce another committee.
It can promise another implementation date.
But permanently increasing the cost of retaining medical professionals requires a long-term fiscal commitment.
That is much harder.
The cost of doing nothing is also rising
The argument for delaying reform is usually that Nigeria cannot afford the cost.
But the alternative also has a cost.
Nigeria pays to train doctors who may subsequently leave.
It loses tax-paying professionals.
It loses clinical capacity.
It loses experienced academics.
It loses research capacity.
It then has to spend more money expanding training and recruiting replacements.
In other words, the country may be trying to save money on retention while paying repeatedly for the consequences of poor retention.
That is an increasingly expensive strategy.
The real test is not whether the strike is called off
The Federal Government can probably prevent the immediate strike if it reaches an agreement with NAMDA before the deadline.
But that would only solve the immediate crisis.
The more important test is what happens afterwards.
Will the government simply settle the outstanding allowances and return to business as usual?
Or will it recognise the medical lecturers’ dispute as a warning about the country’s wider health workforce strategy?
Nigeria’s medical workforce problem cannot be solved by producing more doctors alone.
It requires retaining the doctors already trained, keeping experienced academics in universities, improving teaching hospitals and creating professional and financial incentives strong enough to compete with the international market for Nigerian medical talent.
The irony is becoming difficult to ignore.
Nigeria is trying to solve its doctor shortage by expanding the pipeline while allowing pressure to build on the people who keep that pipeline running.
The NAMDA strike threat has therefore turned a dispute over allowances into a much larger question about the future of medical education in Nigeria.
If the country wants more doctors, it first needs to make sure there are enough people left to teach them.
