Nigeria’s health authorities are pressing ahead with plans to place a hard ceiling on how long locum doctors and other temporary medical staff can work each week, a move officials say is aimed at protecting both exhausted health workers and the patients who depend on them.
Under the draft policy taking shape at the Federal Ministry of Health and Social Welfare, locum doctors, nurses, and other temporary healthcare personnel would be barred from working more than 48 hours in any given week, a limit that would apply across weekdays and weekends alike, effectively closing a loophole that has allowed some facilities to stack back-to-back shifts on temporary staff with little oversight.
The push for regulation follows mounting evidence that Nigeria’s health workforce is operating under punishing, and often unsafe, conditions.
A national study of resident doctors found their average working week stretched past 106 hours, with surgical residents logging even more, well above what most health systems worldwide would consider tolerable.
Nigerian resident doctors routinely endure a mean of about 106 hours weekly, with surgical residents clocking an average of roughly 123 hours weekly.
Many of those hours come in the form of marathon on-call stretches; researchers found doctors were often kept on duty continuously for up to 24 hours during weekday on-calls and 48 to 72 hours during weekend on-calls, getting only about four hours of sleep across those shifts.
The strain has been compounded by an acute shortage of medical personnel. Nigeria’s doctor-to-patient ratio has been estimated at roughly 1 to 9,083, far below the roughly 1-to-600 ratio recommended by health bodies, a gap driven in part by the continuing emigration of skilled clinicians seeking better pay and working conditions abroad.
With hospitals chronically understaffed, many facilities have leaned heavily on locum doctors to plug rosters, sometimes pushing them into shifts that exceed 48 hours, an arrangement health advocates say endangers both providers and the patients they serve.
The human cost of the status quo has occasionally broken into public view. Reports of a doctor’s death after reportedly working 72 straight hours at the Lagos University Teaching Hospital became a rallying point for calls to overhaul how hospitals schedule and deploy staff, particularly temporary hires who often have the least bargaining power over their hours.
The proposed 48-hour cap grows out of a broader reform effort launched earlier this year. In January, the Ministry of Health and Social Welfare inaugurated two ministerial committees to tackle long-running disputes in the health sector, one of them focused squarely on work hours and locum practices.
That committee was mandated to conduct a nationwide audit of work hours and shift patterns, assess the impact on patient outcomes and workers’ wellbeing, and develop a national policy on safe hospital work hours, rostering, and locum engagement, including maximum duty hours, rest periods, and pathways for moving locum staff into permanent employment. It was given 12 weeks to deliver an initial report.
Announcing the committees, Minister of State for Health and Social Welfare Dr. Iziaq Adekunle Salako described the intervention as part of the government’s broader effort to reform the healthcare system and protect health workers’ welfare, framing the recommendations as part of a “new deal” for health professionals intended to reduce industrial unrest and strengthen healthcare delivery nationwide.
The work-hours committee is chaired by the ministry’s Director of Hospital Services and includes representatives from regulatory bodies, hospital management, and health workers’ unions and professional associations.
Locum shifts have become an increasingly important, if informal, pillar of doctors’ income in Nigeria, particularly for younger physicians navigating a demanding residency system on modest salaries.
Industry estimates suggest locum work can add anywhere from roughly ₦100,000 to over ₦300,000 to a doctor’s monthly earnings, on top of base pay under the CONMESS government salary structure.
The financial incentive, combined with staffing shortfalls at many hospitals, has made it common for doctors to take on locum shifts alongside their substantive roles, raising the risk that a physician’s combined hours across multiple employers could still leave them dangerously fatigued, even if no single employer breaches the proposed cap.
It remains to be seen how the ministry intends to enforce the 48-hour limit in practice, whether through licensing conditions, penalties for hospitals that violate it, a central registry tracking locum doctors’ hours across facilities, or some combination of measures.
Questions also linger over how rest periods, transition pathways from locum to permanent posts, and compliance monitoring will be structured once the policy is finalized.
The policy remains in draft form, with the ministry’s committees continuing to consult stakeholders, including hospital administrators, regulatory bodies, and unions such as the Nigerian Medical Association and the National Association of Resident Doctors, before any formal rollout.
Health sector observers say the real test will lie not in setting the 48-hour figure itself, but in ensuring hospitals starved of staff can realistically comply without simply leaving shifts uncovered.
For now, the announcement marks one of the clearest signals yet that Abuja intends to formally regulate a corner of the health workforce that has, until now, operated largely outside official oversight.
WHAT YOU SHOULD KNOW
Nigeria is moving to cap locum doctors’ working hours at 48 per week, including weekends, because the current system has pushed health workers into dangerously long shifts (often 100+ hours weekly, with some stretches lasting 48-72 hours straight) driven by a severe doctor shortage.
This isn’t just a scheduling reform; it’s a patient-safety and workforce-survival measure, born from real cases of doctors collapsing or dying from overwork.
The policy is still in draft form, so its real impact will depend on how strictly it’s enforced across understaffed hospitals that rely heavily on locum staff to function.
