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Nigeria History of Modern Medical Services
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 a
major
role in the supply of modern health care facilities in
Nigeria.
The Roman Catholic missions predominanted, accounting for
about
40 percent of the total number of mission-based hospital
beds by
1960. By that time, mission hospitals somewhat exceeded
government hospitals in number: 118 mission hospitals,
compared
with 101 government hospitals.
Mission-based facilities were concentrated in certain
areas,
depending on the religious and other activities of the
missions.
Roman Catholic hospitals in particular were concentrated
in the
southeastern and midwestern areas. By 1954 almost all the
hospitals in the midwestern part of the country were
operated by
Roman Catholic missions. The next largest sponsors of
mission
hospitals were, respectively, the Sudan United Mission,
which
concentrated on middle belt areas, and the Sudan Interior
Mission, which worked in the Islamic north. Together they
operated twenty-five hospitals or other facilities in the
northern half of the country. Many of the mission
hospitals
remained important components of the health care network
in the
north in 1990.
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, for many of
the first
generation of Western-educated Nigerian doctors. In
addition, the
general education provided by the missions for many
Nigerians
helped to lay the groundwork for a wider distribution and
acceptance of modern medical care.
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. Unlike the missionary facilities, these were,
at least
initially, solely for the use of Europeans. 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 hospital in Jos,
for
example, was founded in 1912 after the initiation there of
tin
mining.
World War I had a strong detrimental effect on medical
services in Nigeria because of the large number of medical
personnel, both European and African, who were pulled out
to
serve in Europe. After the war, medical facilities were
expanded
substantially, and a number of government-sponsored
schools for
the training of Nigerian medical assistants were
established.
Nigerian physicians, even if trained in Europe, were,
however,
generally prohibited from practicing in government
hospitals
unless they were serving African patients. This practice
led to
protests and to frequent involvement by doctors and other
medical
personnel in the nationalist movements of the period.
After World War II, partly in response to nationalist
agitation, the colonial government tried to extend modern
health
and education facilities to much of the Nigerian
population. A
ten-year health development plan was announced in 1946.
The
University of Ibadan was founded in 1948; it included the
country's first full faculty of medicine and university
hospital,
still known as University College Hospital. A number of
nursing
schools were established, as were two schools of pharmacy;
by
1960 there were sixty-five government nursing or midwifery
training schools. The 1946 health plan established the
Ministry
of Health to coordinate health services throughout the
country,
including those provided by the government, by private
companies,
and by the missions. The plan also budgeted funds for
hospitals
and clinics, most of which were concentrated in the main
cities;
little funding was allocated for rural health centers.
There was
also a strong imbalance between the appropriation of
facilities
to southern areas, compared with those in the north.
By 1979 there were 562 general hospitals, supplemented
by 16
maternity and/or pediatric hospitals, 11 armed forces
hospitals,
6 teaching hospitals, and 3 prison hospitals. Altogether
they
accounted for about 44,600 hospital beds. In addition,
general
health centers were estimated to total slightly less than
600;
general clinics 2,740; maternity homes 930; and maternal
health
centers 1,240.
Ownership of health establishments was divided among
federal,
state, and local governments, and there were privately
owned
facilities. Whereas the great majority of health
establishments
were government owned, there was a growing number of
private
institutions through the 1980s. By 1985 there were 84
health
establishments owned by the federal government (accounting
for 13
percent of hospital beds); 3,023 owned by state
governments (47
percent of hospital beds); 6,331 owned by local
governments (11
percent of hospital beds); and 1,436 privately owned
establishments (providing 14 percent of hospital beds see;
table 6, Appendix).
The problems of geographic maldistribution of medical
facilities among the regions and of the inadequacy of
rural
facilities persisted. By 1980 the ratios were an estimated
3,800
people per hospital bed in the north (Borno, Kaduna, Kano,
Niger,
and Sokoto states); 2,200 per bed in the middle belt
(Bauchi,
Benue, Gongola, Kwara, and Plateau states); 1,300 per bed
in the
southeast (Anambra, Cross River, Imo, and Rivers states);
and 800
per bed in the southwest (Bendel, Lagos, Ogun, Ondo, and
Oyo
states). There were also significant disparities within
each of
the regions. For example, in 1980 there were an estimated
2,600
people per physician in Lagos State, compared with 38,000
per
physician in the much more rural Ondo State.
In a comparison of the distribution of hospitals
between
urban and rural areas in 1980, Dennis Ityavyar found that
whereas
approximately 80 percent of the population of those states
lived
in rural regions, only 42 percent of hospitals were
located in
those areas. The maldistribution of physicians was even
more
marked because few trained doctors who had a choice wanted
to
live in rural areas. Many of the doctors who did work in
rural
areas were there as part of their required service in the
National Youth Service Corps, established in 1973. Few,
however,
remained in remote areas beyond their required term.
Hospitals were divided into general wards, which
provided
both outpatient and inpatient care for a small fee, and
amenity
wards, which charged higher fees but provided better
conditions.
The general wards were usually very crowded, and there
were long
waits for registration as well as for treatment. Patients
frequently did not see a doctor, but only a nurse or other
practitioner. Many types of drugs were not available at
the
hospital pharmacy; those that were available were usually
dispensed without containers, meaning the patients had to
provide
their own. The inpatient wards were extremely crowded;
beds were
in corridors and even consisted of mattresses on floors.
Food was
free for very poor patients who had no one to provide for
them.
Most, however, had relatives or friends present, who
prepared or
brought food and often stayed in the hospital with the
patient.
By contrast, in the amenity wards available to wealthier
or elite
patients, food and better care were provided, and drug
availability was greater. The highest level of the
Nigerian elite
frequently traveled abroad for medical care, particularly
when a
serious medical problem existed.
In the early 1980s, because of shortages of fuel and
spare
parts, much expensive medical equipment could not be
operated.
Currency devaluation and structural adjustment beginning
in 1986
exacerbated these conditions. Imported goods of all types
doubled
or tripled in price, and government and public health care
facilities were severely affected by rising costs,
government
budget cuts, and materials shortages of the late 1980s.
Partly as
a result of these problems, privately owned health care
facilities became increasingly important in the late
1980s. The
demand for modern medical care far outstripped its
availability.
Medical personnel, drugs, and equipment were increasingly
diverted to the private sector as government hospitals
deteriorated.
Government health policies increasingly had become an
issue
of policy debate and public contention in the late 1980s.
The
issue emerged during the Constituent Assembly held in 1989
to
draft a proposed constitution. The original draft reported
by the
assembly included a clause specifying that free and
adequate
health care was to be available as a matter of right to
all
Nigerians within certain categories. The categories
included all
children younger than eighteen; all people sixty-five and
older;
and all those physically disabled or handicapped. This
provision
was, however, deleted by the president and the governing
council
when they reviewed the draft constitution.
Data as of June 1991
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