Hospitals adopt casual labour for doctors to survive

…as rising cost, japa worsen challenges in sector

The problems of the health sector seem to be taking deeper dimensions with many hospitals, especially the private one, resorting to casual labor for medical professionals to remain afloat.

Beyond the wave of  growing emigration of Nigerian medical professionals  to Europe, Asia and the Americas in search of greener pastures, which has been the situation in the past decade, high cost of operations imposed on the sector so nice 2023, has gravely impacted adversely on them making extremely difficult to survive.

The twin policies of fuel subsidy removal and exchange rate unification of this government have increased operating cost by over 100 percent, which is threatening their survival. Most hospitals no longer use generating set to power their operations, which means they barely use electricity in the day since public power supply is erratic and inconsistent, and also very expensive. They only run on generators for a short period at night to conserve fuel and reduce cost.

Earlier this year, Nigerians were shocked to learn that the University College Hospital, UCH, Ibadan, was using candles to perform surgery, as they public power was suspended over huge debt, and doctors had to go strike to draw attention to the problem.

High cost of medical treatment has brought about a drastic drop in patients’ patronage, which in turn has led to fall in the fortunes of most hospitals. This in turn is fueling the exodus of health professionals, as the working conditions and welfare take further tumble to the misfortune of patients.

No Ending Exodus

The Nigerian Association of Resident Doctors (NARD) alleged  that 1,417 members relocated to the UK and U.S in 2023. In the first nine months of 2023, over 900 doctors left for Europe, according to NARD; 18,949 doctors left Nigeria in the past 20 years, with 3,974 leaving in 2024 alone.

Over 10,000 Nigeria-trained doctors are practicing in the UK, according to the Nigerian Medical Association (NMA).

This brain drain has resulted in a significant shortage of doctors, with Lagos State needing an additional 33,000 doctors to meet the shortfall. Although, there are vacancies in public hospitals for professionals, especially doctors, nurses and technologists, there is embargo on employment by government in a bid to keep down personnel costs. So, many doctors take whatever job available, while bidding their time to Japa. Here many do several jobs on part-time to survive.

Business Hallmark’s investigations reveal staggering cases of this casualization among hospitals, who  employ these doctors without benefits, or job security, and pay them less compared to their colleagues on permanent employment, forcing some of them to leave the profession.

The case of Dr. Abiodun Tanimola is an uncanny symbol of this growing phenomenon of casualization.

For the past five  months, he claimed to has worked  tirelessly as a locum doctor in a government-owned hospital located in the North Central state of Kogi.  Day and night, according to him,  he attended to patients with  diverse conditions ranging from minor infections to  emergencies.

A senior doctor  at Kogi State Specialist Hospital, Lokoja, who preferred anonymity told Business Hallmark that “The health sector is itself in intensive care unit, needing surgical operation. The phenomenon of locum doctors has come to stay until government addresses the challenge in the sector with sincerity.  If nothing is done the sector may collapse.”

No Hope in Sight

He  maintains calm posture that belies the storm in his mind as he stands  shoulder to shoulder with permanent staff in the wards, writes prescriptions, conducts reviews, and performs life-saving procedures. But unlike his colleagues,  Tanimola goes  home with nothing, not even the promise of a paycheck.

“I keep making appearances simply because I don’t want to risk giving up  the job altogether. But by the end of the second month without pay, I was borrowing to survive,”  Tanimola told Business Hallmark.

“When I could no longer meet the basic needs I had to resort to patronizing online loan apps. I’m in debts to many now and they keep harassing me.

“I am a doctor, but I feel like I am nobody, I feel drained out, harassed by the reality in my country.

Dr. Onietan Ayantiwon, a retired consultant gynaecologist, told Business Hallmark that “politicians have done great damage to this country, particularly the health sector, that amounts to war crime. They take their children and family abroad when sick, and pay less attention to making the system works. These junior doctors are leaving the country after gaining small experience because they are exploited, some of them are treated as casuals of society, with poor pay, and not entitled to the benefits their colleagues whose employment is regularized enjoyed.”

For Dr.  Tosin  Abanikonda, everyday is agony day, as he often sits on his couch in his two-bedroom apartment at Iyana Ipaja. He could not believe that three years after graduation, he would be counted among the casuals of life without proper employment,  wife and children. He often feels the sadness within when neighbours stand in awe of him, saying, “doctor, doctor!, unawares of his low pay and the difficulties he is experiencing.

To his parents  back in Ekiti, he is a symbol of their  success: their son  is now a working doctor. But for Tosin, the ID feels more like a burden than a badge of honour.

“I used to think the hard part was getting through medical school. I didn’t know the real suffering would start after I became a doctor,” he bitterly told our correspondent.

Survival is the Game

Tosin works as a locum doctor, employed temporarily with no job security, meagre pay, and no access to the standard benefits given to full-time staff.

After completing his Houseman-ship, he was offered a contract position at the teaching hospital, where he trained, and though grateful at first, reality soon set in.

He said out  of his take-home salary of N115,000,  his monthly transport bill alone costs  nearly N46,000, almost half of his income.

He revealed the emotional toll he has passed through, adding that, “What is left after transport, feeding, and rent? Nothing. Most months, I am in the minus.”

” My parents now need help for  medications, upkeep, and supporting younger siblings. What!? I’m forced to  make excuses or send paltry sums that leave me deeply ashamed.

“I am supposed to be the one lifting my family now. But I still depend on them. I still call my brother at the end of the month to ask for small help, like N5,000 here and N10,000 there. It breaks me.

Tosin, who has been under temporary employment for more than two years, lamented that he remains stuck in a contract that offers him no pathway to progress.

Dr. Gift Okonta is also a victim of casualisation at a private hospital in Lagos. “I can’t mention where I work, if I did I would be sacked. I qualified as a medical doctor four years ago, came to Lagos to seek greener pastures, but now the green is tearing me apart. He noted that,  “Some of my friends have left the country. Those who stayed are either full staff or, like me, stuck in these ghost roles. We are seen, but we are not really there.

“I heal others, but I am not even surviving. This is not what we signed up for.”

Business Hallmark learnt that  locum employment (casual or temporary medical staffing) was  the initiative of the government to quickly fill staffing gaps in hospitals, especially during periods, when bureaucracy delayed official recruitment into the federal scheme of service.

Business Hallmark gathered that some are paid by the hospital directly, not the federal government, and the amount often depends on what the hospital can ‘afford’.

A senior staff in one of the government hospitals in Lagos confided in this medium that “We pay them directly depending on what we can afford, we know it’s not what they deserve but since there’s no money we can’t help the situation.

“Nowadays, we charge patients, who are on health insurance, especially if we look at the conditions, many of them owe us huge sums, so we prefer to ask them if they can pay before we proceed.

Temporary Policy Permanent

The initiative behind it is that locum roles were meant to last only a few weeks or months, during which the facility would complete the proper documentation and budgeting needed for permanent employment. Locum doctors would then migrate into permanent positions, enjoying full benefits, job security, and access to career progression.

However,  the economic meltdown and sheer opportunism have allowed this emergency initiative to morph into  a permanent system of exploitation.

Discreet investigations by Business Hallmark reveal  that many Nigerian hospitals, especially federal teaching hospitals and specialist centres,  depend largely on  locum staff to function daily.

It was also discovered that because locum doctors’ jobs are not covered or offered protection by civil service rules, they are often at the mercy of hospital administrators.

Experts and stakeholders in health sector, such as Dr. Anyantiwon have condemned the practice  as they  averred that the current use of locum employment in Nigerian hospitals  is nothing but casualization of labour, which is simply  a practice where workers are kept in insecure, poorly paid positions to reduce costs and avoid long-term obligations.

They  decried a situation where by  locum doctors, despite having  the same medical degrees, licences, and responsibilities like full-time colleagues, are now treated as second-class professionals, mired in a  labyrinth  of temporary work, limited benefits, and economic instability.

The President of the Nigerian Association of Resident Doctors, Dr Tope Osundara, has decried the practice, frowning at the exploitative tendency and  lamenting that locum employment, originally intended as a temporary measure  is now being used to keep doctors on insecure contracts for months and even years.

“This locum employment has become labour casualisation. Doctors on locum contracts have no job security, no protection under labour laws, and often face arbitrary dismissal. It is unfair and unsustainable,” Osundara said.

Investigations by this medium showed  that about 564 locum doctors are currently  in exploitative employment in hospitals across the country to temporarily fill staffing gaps and sustain healthcare delivery amid a worsening shortage of medical personnel.

He noted that  the exodus of doctors has  led to  a doctor-to-population ratio of 3.9 per 10,000, which is far below the global minimum standard.

Pate  stated that  that training one doctor costs more than $21,000, representing a major financial loss for Nigeria.

He expressed deep concern over the exodus of medical personnel from Nigeria,  noting that  only 55,000 licensed doctors are left to serve the growing population of over 200 million.

One internal document from a federal hospital obtained by our correspondent clearly stated, “Temporary appointments may be made by the Chief Medical Director where, because of exigencies of the service, it is not possible to conduct the usual interviews for appointment. An offer of temporary appointment on locum tenens basis may be made pending such time the formal interview would be arranged, at which time, without prejudice, the locum appointee should be interviewed within three months.”