Health Care Services in Colonial Nigeria

 

The challenges posed by a hostile environment infested with mosquito and other potent disease causing organisms provided incentives and need for medical care aimed at protecting early European explorers. However with the establishment of the colonial government in several coastal trading centers, formal medical services were established for the colonial military, expatriates and a few indigenous people living close to their quarters for the purpose of rendering services to them. Later on the quest for evangelism by missionaries led to the establishment of health care services for general Nigerian populace.

Emergence of Modern Medical Services

The beginning of orthodox medical practice in Nigeria could be traced to 1854, when Dr Baikie introduced quinine, which greatly decreased mortality and morbidity related to Malaria among the western expeditioners. Earlier on, this disease posed a serious threat to the explorations of Mungo Park and Richard Lander. However this early form of health care introduced by the colonial master was tailored towards their own interest not that of indigenous populace. It was the church missionaries that first established health care services for the people. Throughout the ensuing colonial period, the religious missions played a major role in the supply of modern health care facilities in Nigeria .Prominent among these were the Roman Catholic mission, the Church Missionary Society (Anglican) and the American Baptist Mission, as well as the Sudan United Mission, which concentrated on middle belt areas, and the Sudan Interior Mission, which worked in the Islamic north. The first health care facility in the country was a dispensary opened in 1880 by the Church Missionary Society in Obosi, followed by others in Onitsha and Ibadan in 1886.

However, the first hospital in Nigeria was the Sacred Heart Hospital in Abeokuta, built by the Roman Catholic Mission in 1885. The missions also played an important role in medical training and education, providing training for nurses and paramedical personnel and sponsoring basic education as well as advanced medical training, often in Europe.

The British colonial government began providing formal medical services with the construction of several clinics and hospitals in Lagos, Calabar, and other coastal trading centers in the 1870s. Services were later extended to African employees of European concerns. Government hospitals and clinics expanded to other areas of the country as European activity increased there.

The establishment of the military headquarters in Lokoja in 1900 led to establishment of medical services there, the same applied to calabar, where incidentally, the first government hospital for civilians, the St. Margaret's Hospital, was built in Calabar in 1891.Other military health facilities were later established in other parts of the country following military activities associated with the first world war(1914-1918).The detrimental effects of the two world wars affected medical manpower as many were redeployed to serve in Europe. However after the war, medical facilities were expanded substantially, and a number of government-sponsored schools for the training of Nigerian medical assistants were established.

The colonial government tried to extend modern health and education facilities to much of the Nigerian population partly in response to nationalist agitation. The announcement of ten-year development plan in 1946 gave birth to University College Ibadan in 1948.A number of schools of pharmacy and nursing were also established.

Early Organization and Administration of Health Care

The first centralization of control of health services in West Africa emerged with health services in Gambia, Sierra Leone, Ghana (then Gold Coast) and Nigeria being merged and controlled by central office in London. However as health care management became more complex especially with the expansion of medical services with industrialization; the central administration of health care services became regionalized, with medical services being controlled by regional governments between 1952-1954.Meanwhile the 1946 health plan established by the Ministry of Health to coordinate health services throughout the country, including those provided by the government, by private companies, and by the missions, also budgeted funds for hospitals and clinics, most of which were concentrated in the main cities. Consequent to the regionalization of health care services, 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 budget of the States, the state governments were free to allocate the health care budget as they deemed fit.

Emergence of Preventive Health Care Services in the colonial times

Preventive health care services (services aimed at preventing the occurrence of disease), did not necessary evolve at a different time as the role of environmental determinants in disease causation was quite appreciated by the colonial masters. Environmental sanitation, town planning etc were seen as measures of protecting public health. However the motives and methods of public health measures in the colonies differed significantly from those of Europe. The primary goal in those colonies according to Stock(2009), was to protect the health of colonial officials and troops from alleged threat to health from the natives‘ communities .Hence at the initial times what was achieved by public works in Europe was achieved by racial segregation in the colonies. There was a free zone (Cordon Sanitaire) built between the colonial and indigenous settlements. European townships were to be separated from the African settlements by cordon sanitaire of at least 350 and later 410 yards. No building was allowed within this zone. The cordon sanitaire according to report was necessary to prevent fever carrying mosquitoes originating in the indigenous communities and to minimize the risk of fires. It was also necessary to protect Europeans from drumming and similar disturbances emanating from African quarters according to Lugard (1970).

This was the situation in Northern Nigeria, where the British officials, non -official expatriates and Nigerian residents within the townships lived in separate clusters. Early medical reports as reported by Stock (2009), contained references to sanitary measures and their rigid enforcements in the townships. Mosquito control through the drainage or filling of potential breeding sites, clearing of grasses and prohibition of African children and cattle keepers passing through European areas feature prominently in sanitation programs. Regulations for organization of European townships were contained in several ordinances of colonial period. In order to strengthen environmental sanitation, the colonial; masters appointed British sanitary inspectors and their Nigerian aides who served as assistants. Their basic function was sanitary inspection.

The roles of these inspectors were made more relevant during the bubonic plague epidemic of 1924. Environmental sanitation till date has continued to be one of the cornerstones of preventive health services in Nigeria. Several programs have been launched at both federal and state levels. However some of these programs lacked consistency and sustainability.

History of public health or preventive health in Nigeria cannot be concluded without mentioning the roles played by Dr Ladipo Oluwole. Dr Oluwole was born to an Anglican Bishop, Isaac Oluwole in 1892.He returned to Nigeria in 1918, after graduating with MB.CHB from the University of Glasgow.

 In 1925, Dr Isaac Ladipo Oluwole was appointed first African Assistant Medical Officer of Health in Lagos He founded the first School of Hygiene in Nigeria, at Yaba, Lagos, providing training to Sanitary Inspectors from all parts of Nigeria. He re-organized sanitary inspection procedures in the port of Lagos to control the spread of bubonic plague. The plague, which broke out in unsanitary shanty towns in Lagos, caused many deaths between 1924 and 1930.

More so, Dr Oluwole opened the Massey Street Dispensary, reclaimed swampy islands to aid in malaria control and built a new abattoir to improve food hygiene. Oluwole started the first school health services in Lagos in 1925.He introduced regular sanitary inspections and vaccinations of children. He started a Healthy Baby Week and opened the first old people's home before being appointed Medical Officer of Health in 1936.He was awarded the Order of the British Empire in 1940. He died in 1953 being recognized as the father of public health in Nigeria.

The emergence of modern health care services in Nigeria could be traced to the colonial era. This was in attempt to contend the threats posed by malaria. The pattern of health care during this period showed marked urban-rural disparity whereby the priority of health service was to serve a few privileged individuals in Government quarters. This foundation has continued to trail health care services in Nigeria till today, despite the deployment of various policy documents to correct the imbalance.