Health Care Services in the Post- Colonial Period


Health Care Services in the Post- Colonial Period

Following independence, Nigeria inherited the same health system developed by the colonial masters and the weakness of that system especially its being more clinically oriented, more curative at the detriment of preventive services were altogether inherited. Most of the projects and services were located at the urban areas, while the rural areas were grossly neglected. It was the desire to correct these anomalies and improve performance that led to the articulation of various developmental plans that followed.

 Health care in Immediate Postcolonial Period

The state of Nigerian health sector by 1960 shows that it was more clinically oriented, providing dominantly curative components of health care. Preventive health care was grossly neglected. The situation was worsened by the fact that these services were concentrated in the urban, serving roughly about 10-15% of Nigerian population. The first ten-year colonial National development plan ended in 1956.Following independence a first National Development plan (1962-1968) was put in place.

It contained ground work for the promotion of industrial development, building of hospitals in major cities, dispensaries and maternity homes in few rural towns and villages. This plan seems to have been patterned after that of the colonial masters whose priority was to provide health care in few towns and cities occupied by expatriates.

The obvious deficiencies of this plan necessitated the Second National Development Plan (1970-1974), The health component of this plan was aimed at correcting some of the deficiencies in health care delivery. The objectives of this phase even though well defined and good were not matched well with articulated projects and closely defined policies. Environmental Sanitation though recognized by the Nigerian Constitution and was still effective in the post independence period for example routine house to house inspection was still effective in the maintenance of Environmental Sanitation.

However, political interference with the statutory role of Sanitary Inspectors led to the collapse of the house to house inspection programme and contributed to the poor sanitary conditions in the country.

Meanwhile another remarkable dimension in the evolution of preventive care occurred in 1966 during the outbreak of small pox in Nigeria. WHO strategy and recommendation was 100% vaccination of the susceptible communities. The resurgence of the disease was seen in West Africa and India despite 90% and 80% vaccination respectively.

Unfortunately Nigeria recorded a delay in Vaccine supplies during this period. This led to evolution of surveillance and containment measures. Program staff made efforts to locate new cases and isolate infected villages which could then be vaccinated with the limited supplies. A reporting network using the available radio facilities was established to locate new cases. Containment teams moved swiftly to isolate infected persons and to vaccinate susceptible villages.

Hence it was demonstrated that an alternative strategy of surveillance and containment measures such as isolation, vaccination of high risk groups could break the transmission chain of smallpox, even when less than half the population was eventually vaccinated.

Health Care in the Third and Fourth Development Plan

The Head of State, Lt Col Yakubu Gowon, in 1975, announced the Basic Health Service Scheme (BHSS) as part of the Third National Development Plan (1975-80). The objectives of the scheme were to increase the proportion of the population receiving health care from 25 to 60 percent, correct the imbalances in the location, distribution of health institutions and provide the infrastructures for all preventive health programmes such as control of communicable diseases, family health, environmental health, nutrition and others, and establish a health care system best adapted to the local conditions and to the level of health technology (Sorungbe, 1989). There was a concerted effort for the first time to meet the World Health Organization‘s (WHO‘s) standard of 1 doctor -10,000 population ratio. Hence establishment of medical institutions and development of health manpower was given an important place.

The plan however was affected by mal-distribution of health personnel and facilities between rural and urban centers and the budgetary allocation to health at all levels of government. Subsequently, there was the fourth National Development plan (1981-1985).

The major policy objectives and programmes of this plan were:

(i) Establishment of 3-tier comprehensive health system (primary, Secondary and tertiary)

(ii) Concurrent health care responsibility from 3 levels of Government.

(iii) Establishment of Basic Health Services Scheme (BHSS) and of primary health care for all

(iv) Establishment of Local Government Areas (LGAs) as basic Implementation unit.

(v)  Establishment of BHSS for a population of 50,000.

(vi)  Establishment of 4 categories of community health workers

(vii) Utilization of village voluntary traditional practitioners and leaders.

(viii) Discouragement of expensive construction.

(ix) Decentralization of decision-making.

(x)  More balanced expenditure between hospitals and BHSS.

The problem with this scheme was its total neglect. The Federal Government in particular focused much more attention on the establishment of teaching and specialist Hospitals. This was reflected in the budgetary allocations for Health capital projects and programme as contained in the plan. Moreover the downward turn in Nigeria's economy began during this period, leading to major cuts in budgetary allocations.

The lack of equity that marked health care delivery in the colonial times continued in the postcolonial health care delivery experience. The government came up with fairly articulated plans with emphasis on Basic Health Services scheme (BHSS).However these programmes were poorly implemented, poorly financed and unable to correct imbalance in health service delivery.

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