West African Unions Take a Stand as Health Systems Reach Breaking Point

Across West Africa, the health system is under strain. Health centres are short-staffed, hospitals are underfunded, thousands of trained professionals are leaving the continent, and many others remain without jobs while those in service are pushed to the limits. It is against this backdrop that the West African Health Sector Unions Network (WAHSUN) gathered in Abuja, Nigeria to confront this crisis that is expanding day by day. As the network puts it plainly, “Health workers are the backbone of healthcare delivery and must be protected, valued, and empowered.”  

At the opening, Nigeria’s Coordinating Minister of Health, Professor Muhammad Ali Pate, acknowledged the depth of the challenge and called for increased investment in the sector. He pointed to the need for stronger funding and confirmed that the Nigerian government would move to resolve long-standing issues, including salary structure adjustments and delayed agreements with health workers. It was a message that signaled recognition but also raised expectations among unions who would monitor the implementation of this commitment.  

Union leaders were direct about what is at stake. Across the region, health budgets remain far below the 15 percent target agreed under the Abuja Declaration. As WAHSUN warned, “over two decades after the Abuja Declaration, most countries are still far from allocating 15% of their budgets to health.” The result is a system stretched thin. And one where infrastructure is weak, basic equipment is lacking, and workers are forced to bear the burden. WAHSUN made it clear that without urgent and sustained public investment, the gap between demand and capacity will continue to widen. 

The crisis is not only about funding. It is also about workforce. Delegates described the growing wave of migration as disastrous for the continent as health workers leave in search of better conditions. “The escalating migration of skilled health professionals poses a critical threat to the sustainability of our health systems in this region,” the network warned. At the same time, thousands of trained professionals remain unemployed due to hiring freezes and policy constraints. Delegates noted that “there is a clear contradiction of high unemployment among trained health professionals despite critical workforce shortages.” In Ghana alone, more than 74,000 nurses and midwives are still waiting for opportunities, even as health facilities struggle to cope. This is predicted to be worse by 2028. 

Those still in service are working under conditions that continue to deteriorate. “Persistent poor working conditions, excessive workload and inadequate welfare continue to define the reality of health workers,” WAHSUN noted. Community health workers, who keep primary care systems running, remain among the most affected. As highlighted during the discussions, “Community health workers form the backbone of primary healthcare, yet most remain classified as volunteers without protection.” 

There was also immense concerned over African governments' failure to honour their own commitments. “The continued failure of governments to implement negotiated collective agreements is unacceptable,” the network stated. At the same time, unions raised alarm over the direction of reforms in the sector. “The increasing casualisation of labour in the health sector is a violation of workers’ rights and endangers patient safety,” WAHSUN warned, insisting that healthcare is a public good, and the commercialization of essential services must be halted. 

Comrade Baba Aye reminded delegates that change will not come from policy statements alone. “Worker power comes from organizing and collective action, not just from policy commitments. The task is to move beyond periodic meetings and build a continuous presence, through research, campaigns, and coordinated action across borders". As the network reaffirmed, “Trade unions are central actors in shaping equitable, inclusive and people-centred health systems.”  

But the most important question is what happens next. WAHSUN has outlined a path to follow through. 

• WAHSUN committed to demanding governments to meet the 15 percent health budget target. 

• Fightback the spread of privatization and precarious work. 

• Demand large-scale recruitment to address workforce shortages.  

• The network also set regional priorities for the next two years, focusing on primary healthcare financing, migration, and protection of workers in crisis situations. 

• The network will track government commitments, including timelines for salary adjustments and the completion of collective agreements.  

• Affiliates will engage directly with national authorities, while regional leadership will push for accountability through ECOWAS and other bodies.  

• Regular updates, joint actions, and sustained advocacy will be used to keep pressure on governments to deliver. 

These next steps are contained in this communique below. 

There is also a shift in how the network plans to work. Rather than relying on meetings alone, WAHSUN will invest in research on the state of healthcare in the region, strengthen its public voice through statements and campaigns, and expand organizing efforts to reach more workers. The aim is to grow the network through active engagements with governments and regional institutions to address these gaps.