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.
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.
0 Comments