The intendment of the NHSRII for improved health outcomes is that a doctor should finish a call, hand over and go home knowing a rested colleague has taken over. A locum should have a clear contract, regular pay and an end to temporary status. Patients should be treated by a properly staffed team, not one dependent on individual endurance.
In September 2025, Dr Oluwafemi Rotifa, 28, died after being found unresponsive in a call room at Rivers State University Teaching Hospital. The Nigerian Association of Resident Doctors (NARD) linked his death to a reported 72-hour call, while the Nigerian Medical Association in Rivers State said he had been unwell and off duty. The case renewed the scrutiny of doctors’ call hours.
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A Longstanding Workforce Problem
The Federal Government was already examining excessive working hours when the case returned the issue to public attention. In May 2024, the Federal Ministry of Health and Social Welfare acknowledged the strain on doctors; three months later, the National Policy on Health Workforce Migration provided for reasonable hours, health checks and mental health support. Yet, resident doctors continued to report prolonged calls, casual employment, unpaid allowances and staff shortages. In October 2025, NARD capped continuous calls at 24 hours and required a call-free period afterwards.
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At the heart of the problem were vacancies, uneven deployment, leave gaps and delayed recruitment. Hospitals relied heavily on existing staff, while temporary appointments often continued without the protections of substantive employment.
In January 2026, the Ministry established the Ministerial Committee on Work Hour Regulation and Locum Engagement Policy to develop national standards. Its survey of 6,350 health workers found that 39 per cent routinely worked 60–72 hours a week; 11 per cent frequently worked for more than 24 hours without sleep, while 27 per cent did so occasionally. Another 86 per cent received neither overtime pay nor documented time off; 98 per cent reported exhaustion and 76 per cent emotional detachment. The Ministry issued the framework on 13 August.
The Working-hour Standard
The framework covers doctors, nurses, midwives, pharmacists, laboratory scientists, allied professionals and administrators, whether permanent, temporary, contract or locum. It sets a 48-hour week, including weekends, and limits continuous duty, including call, to 24 hours. Routine shifts should not exceed 12 hours, except in emergencies or for exceptional continuity-of-care needs.
Staff must have at least 12 hours between shifts and 24 hours’ rest after any call. Calls are limited to two a week and one weekend call a month, with a one-hour break after six continuous hours. Additional hours must be recorded and compensated through enhanced pay or structured time off.
Fatigue and Patient Safety
Limiting working hours protects staff and patients. Prolonged duty without adequate rest impairs attention, judgment and memory, increasing the risk that a patient’s deterioration will be missed. Patients seldom know how long the clinician treating them has been awake. WHO and ILO analyses also associate working 55 hours or more a week, compared with 35–40 hours, with a 17 per cent higher risk of ischaemic heart disease and a 35 per cent higher risk of stroke.
In a randomised intensive care study, interns regularly working shifts of 24 hours or longer made 36 per cent more serious medical errors. Later research linked extended shifts and weeks exceeding 48 hours to more self-reported errors, occupational injuries and near-miss crashes. Working-hour regulation is therefore part of clinical risk management.
Staffing gaps can turn locum work into permanent work on temporary terms. Each appointment must therefore address a documented gap and receive institutional approval. Contracts may last up to six months, with one renewal; after 12 months’ continuous engagement, the post must become eligible for open, authorised substantive recruitment.
International Practice
Internationally, Nigeria’s weekly limit is protective. The European Working Time Directive caps the average week at 48 hours, including overtime, and normally requires 11 hours’ consecutive daily rest, with exceptions requiring compensatory rest or equivalent protection. England caps trainee doctors’ shifts at 13 hours, with exception reporting, an independent Guardian of Safe Working Hours and financial penalties.
US rules permit an 80-hour average over four weeks and 24 hours of clinical duty, plus four for handover and education — but no new patients — followed by 14 hours off. Singapore allows junior doctors the same average; New South Wales caps non-specialist medical officers’ shifts at 14 hours and requires at least 10 hours’ rest.
Nigeria’s 48-hour limit matches the EU standard and is below the 80-hour averages allowed in the US and Singapore, although England and New South Wales permit shorter shifts. It applies across health professions and forms of employment. The test will be whether rosters protect rest, working hours are accurately recorded, handovers are safe, staff can report violations, and hospitals act when breaches recur.
Staffing and Safe Handovers
But shorter hours do not create the staff needed to cover them. In a six-site paediatric intensive care trial, ending extended shifts increased sleep but coincided with more serious errors and heavier patient loads. Shorter shifts also mean more handovers, adding risk when information is incomplete or responsibility unclear.
Safe rosters require funded posts, the right skills, leave cover and standardised handovers. Workloads must reflect patient volume and clinical intensity, as well as hours. One worker’s rest must not place an unsafe load on another; while recruitment, deployment and retention remain essential.
Locum Employment and Staffing Gaps
Staffing gaps can turn locum work into permanent work on temporary terms. Each appointment must therefore address a documented gap and receive institutional approval. Contracts may last up to six months, with one renewal; after 12 months’ continuous engagement, the post must become eligible for open, authorised substantive recruitment.
Locum personnel must receive monthly pay under the Scheme of Service, payslips, approved leave, public holidays and occupational insurance. Hospitals must induct them into clinical teams and provide safe conditions and suitable call rooms. Comparable treatment and safeguards against temporary contracts filling permanent posts are principles of fixed-term employment.
Records should expose artificial breaks, changed titles or serial locum replacement that perpetuates casualisation.
Nigeria has supported this position internationally. In May 2025, it was among five sponsors of World Health Assembly resolution WHA78.16 on fair remuneration, supportive workplaces and burnout. At WHA79, the Economics of Health for All Strategy linked decent work to wellbeing, productivity and service quality; the amended WHO Global Code placed employment and retention within the response to health-worker migration. NHSRII applies them to rosters, rest, pay and staffing.
NHSRII and Workforce Retention
The framework supplies a workforce standard for the Nigeria Health Sector Renewal Investment Initiative. As NHSRII expands primary, maternal, newborn, emergency and tertiary care, demand for staff will grow. Its Sector-Wide Approach should include hours, missed rest, vacancies, overtime and locum use in federal and state planning.
Nigeria has supported this position internationally. In May 2025, it was among five sponsors of World Health Assembly resolution WHA78.16 on fair remuneration, supportive workplaces and burnout. At WHA79, the Economics of Health for All Strategy linked decent work to wellbeing, productivity and service quality; the amended WHO Global Code placed employment and retention within the response to health-worker migration. NHSRII applies them to rosters, rest, pay and staffing.
The framework advances the National Policy on Health Workforce Migration, linking retention to reasonable hours, wellbeing, training, rural incentives, ethical recruitment, diaspora engagement and data. Nigeria has completed a workforce profile, established the National Health Workforce Registry and begun a health labour market analysis to guide recruitment and distribution.
Hours are only one part of retention. The Ministry reported employing 14,444 health workers in 2024 and approving 23,059 appointments in 2025, with over 70 per cent of these in clinical roles. The Federal Government released ₦10.6 billion for the 2025 Medical Residency Training Fund, followed by another disbursement in 2026. NARD reported omissions and failed transactions.
Safety also affects retention. After 18 cases of assault, intimidation or harassment within a year, the Ministry directed federal hospitals to establish prevention teams, improve access control and reporting, work with law enforcement and support affected staff. NARD continues to seek stronger protection, arrears settlement, payments to omitted residency-fund beneficiaries and meals on call.
Implementation Across the Health System
The circular applies initially to federal tertiary institutions. Extension to state, private and faith-based hospitals will require National Council on Health endorsement or another route. Institutions must revise contracts and rosters, fund overtime and arrange end-of-shift cover.
Records must show rostered and actual hours, including clinical care, administration, teaching, handover and overtime, and be independently auditable. Workers need confidential reporting outside line management. Boards and regulators should review excessive hours, missed rest, overtime payments, rota gaps, locum use and safety events.
The intendment of the NHSRII for improved health outcomes is that a doctor should finish a call, hand over and go home knowing a rested colleague has taken over. A locum should have a clear contract, regular pay and an end to temporary status. Patients should be treated by a properly staffed team, not one dependent on individual endurance.
Chinedu Moghalu is a lawyer, strategic communications expert, and public policy adviser with over two decades of leadership across government, international organisations, and development institutions. Currently, senior special adviser to Nigeria’s coordinating minister of health and social welfare.
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