HOW WESTERN HEALTH CARE BEGAN IN NIGERIA

In pre-explorers and Western traders Nigeria, traditional medicine was the system of health care delivery. Traditional medicine and healing constituted part of the micro cultural evolution of Nigeria, a nation of at least 250 linguistic groups (which some describe as ethnic groups), of which 3 are major groups comprising over 60% of the total population. Although all of these groups share common major culture and macro-tradition, each evolved its own culture and micro-traditions in response to prevailing environmental circumstances.

Traditional healing and medical practitioners included herbalists, divine healers, soothsayers, midwives, spiritualists, bone-setters, mental health therapists and surgeons. In spite of more than 150 years of introduction of Western medicine to Nigeria, traditional healing and medical practices remain a viable part of the complex health care system in some parts of the country today.

Traditional healer treating a patient

Although this traditional system of healthcare evolved separately in different micro-cultures, there is a great deal of philosophical and conceptual similarities. The origin of diseases in Africa was simplistic. It is either an enemy had cast a spell on you or you are being punished by divine powers for your transgression. Although the Arabs have had the distinction of early-organized medical services, there is no recorded evidence of the introduction of such services to Sub-Saharan Nigeria during trade interactions of the fifteenth century.

The same thing is true of the Portuguese and English traders in their interactions with the delta/riverine areas of Nigeria during the later part of the fifteenth century.

The first record of modern medical services in Nigeria was during the various European expeditions in the early-to mid-nineteenth century. The earlier explorations of Mungo Park and Richard Lander were seriously hampered by diseases. In the expedition of 1854, Dr. Baikie introduced the use of quinine, which greatly decreased mortality and morbidity among the expeditioners.

It is still a subject of considerable debate whether the use of quinine by Dr. Baikie was his original discovery or he borrowed the idea from traditional herbalists with whom he interacted in the course of his expeditions. Whatever is the true situation, the use of quinine both as prophylaxis against and as therapy for malaria fever, expanded exploration and trade.

Western medicine was not formally introduced into Nigeria until the 1860s, when the Sacred Heart Hospital was established by Roman Catholic missionaries in Abeokuta. Throughout the ensuing colonial period, the religious missions played major roles in the supply of modern health care facilities to Nigeria.

Prior to that development, the earliest form of Western health care in Nigeria was provided by doctors brought by explorers and traders to cater for their own well being. But subsequently, the Roman Catholic missions, accounted for about 40 percent of the total number of mission-based hospital beds by 1960. By that time, mission hospitals somewhat exceeded government hospitals. 118 mission hospitals, compared with 101 government hospitals. In this regard, tribute must be paid to the Church Missionary Society (Anglican) and the American Baptist Mission. There are several reports of practices within these missionary health care facilities to suggest that they were primarily used as tools for winning converts and expanding their followership.

Health Officers enlightening residents in a village community

Dog heads & Cats in Nigerian Traditional Medicine

Consequently, these facilities were competitive rather than complementary. In spite of this fact, they were of such high quality and this high quality is also evidenced by the fact that the Seventh Day Adventist Hospital in Ilesha as well as the Wesley Guild Hospital in Ile-Ife became the nucleus of the teaching Hospital complexes of major university in Nigeria. Even today, in Nigeria, the Baptist hospitals in Ogbomosho and Eku function as referral centers in the health care delivery matrix. Because of the evangelical functions of these health care facilities, it was left for the government to organize and develop policies for general health care.

It is well known that towards the end of the 19th century, European powers were at war with each other for ownership of the vast rich land of Africa. They established frontiers needed to be secured and so there was a powerful British military presence in Nigeria. For the military, which was located in Lokoja, the British therefore established medical services there. Under the Governor, Lord Lugard, Lokoja was the military headquarters in 1900. Aside military health services, civilian services were also established and it is known that the first government hospital for civilians, the St. Margaret’s Hospital, was built in Calabar in 1889.

At the time World War I (1914- 1918) was ending, present day Nigeria was being born by the amalgamation of the Northern and Southern protectorates. This war produced a lot of military activities in Nigeria, leading to the establishment of several military health care facilities, some of which were left to function as civilian hospitals after the war. With time, several government-owned health care facilities were established, ranging from rural health centers to general hospitals

Traditional orthopedic treatment

Samuel Elufisoye, divining for two clients who are seated across from him, Ife, Nigeria, 1937.

At the turn of the century, medical services, as is the case with some other services, in the Gambia, Sierra Leone, Ghana (then Gold Coast) and Nigeria were merged and controlled by the colonial office in London. This was the first centralization of control of health services in West Africa. The colonial office determined the services that were available and provided the manpower. As health care management became more complex, the central administration of health care services became regionalized, while maintaining some common West African facilities such as the West African Council for Medical Research, which came into being in February 1954.

In Nigeria, specifically, medical services developed and expanded with industrialization. Most medical doctors were civil servants, except those working for missionary hospitals, who combined evangelical work with healing. Among the civil service doctors, one was appointed the chief medical officer, who became the principal executor of health care policies in Nigeria. Along with his several other junior colleagues (senior medical officers and medical officers), they formed the nucleus of the Ministry of Health in Lagos. The details of centralised administration of health services up to this point were complex and they reflected the complex political transformation of the whole region.

Between 1952 and 1954, the control of medical services was transferred to the regional governments, as was the control of other services. Consequently, each of the three regions (Eastern, Western and Northern) set up their own ministries of health, in addition to the federal ministry of health. Although the federal government was responsible for most of the health budgets of the states, the state governments were free to allocate the health care budgets as they deemed fit.

The health care services in Nigeria have been bastardised by planning, as is the case with the planning of most aspects of Nigerian life. The major national development plans are as follows: The first colonial development plan from 1945- 1955 (decade of development), The second colonial development plan from 1956- 1962, The first national development Plan from 1962- 1968, The second national development Plan from 1970- 1975, The third national development plan from 1975- 1980, The fourth national development plan from 1981- 1985, Nigeria’s five year strategic plan from 2004 – 2008. All of these plans formulated goals for nationwide health care services.

Traditional medicine store

The overall national policy for nationwide health care services was clearly stated in a 1954 Eastern Nigeria government report on “Policy for Medical and Health Services.” This report stated that the aim was to provide national health services for all. The report emphasized that since urban services were well developed (by our standards then), the government intended to expand rural services.

These rural services would be in the form of rural hospitals of 20- 24 beds, supervised by a medical officer, who would also supervise dispensaries, maternal and child welfare clinics and preventive work (such as sanitation workers).

The policy made local governments contribute to the cost of developing and maintaining such rural services, with grants-in-aid from the regional government. This report was extensive and detailed in its description of the services envisaged. This was the policy before and during Independence. After independence in 1960, the same basic health care policy was pursued.

By the time the third national development plan was produced in 1975, more than 20 years after the report above, not much had been done to achieve the goals of the nationwide health care services policy. This plan, which was described by retired General Yakubu Gowon, the then head of the military government, as “A Monument to Progress”, stated, “Development trends in the health sector have not been marked by any spectacular achievement during the past decade”. This development plan appeared to have focused attention on trying to improve the numerical strength of existing facilities rather than evolving a clear health care policy.

Area view of Sacred Heart Hospital in Abeokuta

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