This is a moment for heightened urgency in addressing the investments and attention being paid to our public health systems in Nigeria, as globally. Deep inequities and unbalanced approaches to channelling much needed remuneration, respect and investments to prioritise our frontline force have been exaggerated since the onset of the Pandemic.

The unnerving, recent announcement by Nigeria’s National Association of Resident Doctors public strike is the fourth work stoppage by medical residents since the pandemic began.

As the backbone of our public health – health and care workers and CHWs have provided essential health services to communities with the least access to quality care, especially in remote and rural areas- accelerating the attainment of universal health coverage – despite inadequate attention being applied to facilitating decent work, safety, dignity, fair pay and equal leadership they deserve – as the key mutual and multi-directional duty of care.

I remain deeply concerned especially that the state of primary healthcare centres across Nigeria, and how the frontline potential for PHC’s being the first port of call for serious injury and disease, a barrier between life and death for many – is being underutilized.

For years, Nigeria, like many other lower-middle income countries, has struggled to address health worker shortage lagging far behind the WHO suggested doctor-patient ratio of 1:600. With the 19,000 protesting medical residents making up the bulk of health care workers at government hospitals throughout Nigeria, also staffing the majority of the government-run treatment facilities for COVID-19 – their absence at this crucial time is an alarming concern.

This is a period that calls for whole system support as a duty of care – and a greater push for resources, resilience, replenishment towards recommended ratios which of course integrates regular remunerations.

Taking learnings from paradigm shifts recorded in countries such as India, whose medical education system has been able to pull through a major turnaround, successfully doubling the numbers of MBBS graduate (modern medicine training) positions during recent decades – it is not enough to fixate on the excuse of doctor scarcity. As we move forward there is an urgent need to focus on augmenting the fiscal capacity as well as developing much needed infrastructure both in public and private health sectors toward addressing pressing healthcare needs of our growing population.