Medical and Dental Consultants Association of Nigeria (MDCAN) and the National Association of Resident Doctors (NARD) have expressed concerns over the increasing reliance on casual or locum employment for doctors across public hospitals in Nigeria.

They warned that the practice contributes to job insecurity, poor remuneration and worsening the healthcare brain drain.

Speaking on the issue, MDCAN president, Prof. Muhammad Muhammad, described the casualisation of doctors, where specialists are retained on temporary contracts without full employment benefits, as a “common but abnormal practice” that has persisted due to bureaucratic bottlenecks in government employment processes.

“In many hospitals, especially teaching hospitals, newly trained specialists are retained as locum doctors while institutions await government approval, a waiver to make permanent hires. Sometimes this wait can last for two to three years. These doctors continue to offer critical services without the job security, pension, or benefits their permanent counterparts enjoy,” Prof. Muhammad explained.

“It is a common practice, but it’s not normal,” Prof. Muhammad said, explaining that while temporary employment is sometimes used globally to bridge staffing gaps, in Nigeria, it has morphed into an exploitative system due to chronic understaffing and a sluggish recruitment process.

“Unlike other countries where casual workers are paid more due to lack of long-term benefits, in Nigeria, locum doctors are poorly paid, not entitled to pensions, and often face salary delays,” he said.

Prof. Mohammad told LEADERSHIP Weekend that many hospitals, despite critical workforce shortages, are unable to directly absorb doctors due to delays in receiving government waivers, even when the doctors in question were trained within the same institutions.

In the same vein, the president of the National Association of Resident Doctors (NARD), Dr. Osundara Zenith, told LEADERSHIP Weekend that the situation undermines both the healthcare system and the welfare of Nigerian doctors.

“Locum employment is supposed to be a stopgap to replace doctors lost to Japa (emigration), but it has turned into a permanent structure. Many doctors are now casualised, with no pension, no job security, and no decent remuneration. This is worsening the exodus of doctors,” he said.

According to NARD, over 500 to 600 doctors are currently on locum contracts across Nigeria. These doctors are typically paid outside the federal payroll system and instead rely on hospital internally generated revenue (IGR) or ad hoc accounts, which often leads to delayed or inconsistent salaries.

Confirming the country’s deepening workforce crisis, the minister of Health and Social Welfare, Prof. Ali Pate, recently said that Nigeria has only 55,000 active doctors serving over 200 million citizens. Over 16,000 doctors have left the country in the last five years, while another 17,000 are no longer in active service.

The minister revealed that of Nigeria’s 85,000–90,000 registered doctors, only 55,000 were currently practicing in-country. Others are either inactive or practicing abroad, especially in the UK and US.

These numbers show why urgent reforms are needed. “We urge the federal government to fully implement the one-for-one replacement policy so hospitals can recruit immediately when a doctor exits,” Prof. Muhammad said.

He also noted that although a 2024 directive exempted the Federal Ministry of Health from bureaucratic delays in seeking waivers, implementation has remained largely ineffective. “We have the policy on paper but hospitals are still struggling to get approvals and hire,” he stated.

The association maintained that unless the government fast-tracks recruitment processes and ends casualisation, the manpower crisis in Nigeria’s health sector would continue to deepen.