Posted on: Tue 15-07-2025

Nigeria’s healthcare system is facing a silent but deepening crisis—not just in terms of inadequate facilities or shortages of medical supplies, but in the way it treats its most critical asset: healthcare professionals. The Nigerian Medical Association (NMA) and the National Association of Resident Doctors (NARD) have raised fresh concerns over the growing casualisation of medical doctors, particularly in government-owned hospitals. Both bodies have issued an emphatic call for the immediate end to the practice, describing it as exploitative, unsustainable, and a key factor fuelling the country’s worsening brain drain.

Traditionally, the engagement of doctors on temporary contracts, known as "locum" appointments, was introduced as a short-term solution to staff shortages in public health institutions. This system was designed to fill urgent gaps when bureaucratic bottlenecks delayed permanent recruitment into federal or state service schemes. However, what was meant to be a stopgap has now morphed into a dangerous norm.

Investigations by PUNCH Healthwise reveal that today’s locum doctors, despite holding the same qualifications and licenses as their permanently employed counterparts, are often relegated to second-class professional status. They find themselves trapped in cycles of precarious employment—constantly on short-term contracts, denied essential benefits, and subjected to economic uncertainty. Their plight is further exacerbated by the lack of protections under Nigeria’s labour laws, making them vulnerable to exploitation and dismissal without recourse.

Dr Dele Osundara, President of the National Association of Resident Doctors, voiced strong concerns about this growing trend. Speaking in an exclusive interview, he described the abuse of the locum system as a serious threat to the country’s healthcare workforce. According to him, many doctors who initially accepted temporary contracts as a stepping stone into full-time employment now find themselves stuck in these roles for years.

“Some doctors have remained on locum for over two years, with no clear pathway to permanent employment,” he lamented. “You cannot expect doctors to stay committed to a system that undervalues and exploits them. Many are simply counting the days until they can leave the country for better opportunities.”

Osundara further highlighted the dangers of leaving young doctors in a perpetual state of insecurity. Locum doctors, he noted, are often denied hazard allowances, career development opportunities, pensions, or even basic social security protections. Their positions are precarious—should they raise concerns or demand better conditions, they risk being summarily dropped at the end of their contract cycle, sometimes without explanation.

“This is a system that uses the desperation of young doctors to create cheap and disposable labour,” Osundara said. “Hospitals get the work done without making any long-term commitments. There’s no pension, no career progression, no incentives to stay.”

The implications of this practice extend beyond the doctors themselves. A healthcare system that fails to protect and retain its workforce is inevitably setting itself up for collapse. Many of Nigeria’s brightest medical minds are already leaving the country in large numbers, drawn by better opportunities and more dignified work conditions abroad.

Echoing these sentiments, Dr Benjamin Olowojebutu, the First Vice-President of the Nigerian Medical Association, insisted that the federal and state governments must urgently abolish the practice of locum and contract-based employment in public hospitals. He stressed that all doctors in government service deserve permanent and pensionable appointments after a defined probationary period—not years of insecure, temporary contracts.

“Temporary contracts should not exceed one year,” Olowojebutu said. “Anything beyond that becomes systemic exploitation.”

He expressed concern that what was once a temporary measure has now become the default mode of employment for young doctors in Nigeria. Many newly qualified physicians are trapped in this cycle of casualisation, with no access to pensions, health insurance, or job security. Some even face arbitrary salary deductions without explanation or accountability.

“These doctors are treated like expendable tools—brought in when needed and discarded at will,” he added. “How can a government that claims to value healthcare allow such inhumane conditions to persist?”

For both NMA and NARD, dismantling the locum system is not just about fair labour practices—it is about the survival of the country’s healthcare sector. The current model, they argue, is unjust, short-sighted, and detrimental to national health goals. By failing to provide stable career paths for doctors, the system is actively driving skilled healthcare workers out of the country.

“If we want to keep our doctors and build a sustainable healthcare system,” Olowojebutu concluded, “we must treat our medical professionals with dignity and fairness. The era of casualisation has outlived its usefulness. It is time for a fundamental change.”

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