Prior to the arrival of the British in Nigeria, traditional medicine was the basis of health care delivery in the country.
History of Health Services in Nigeria
Basically, traditional medicine involves the healing and medicine practiced by herbalists, divine healers, soothsayers, midwives, spiritualists, bone-setters, mental health therapists and surgeons.
Traditional medicine was based on the premise that diseases were a result of an enemy casting a spell on you or due to a punishment by divine powers for your sins.
After Western-style medicine was introduced in Nigeria during the colonial period, traditional medicine remained an important part of the healthcare system in the country. In fact, an informal survey in Benin City in 1988 revealed that for every sign-post that indicated a Western-style clinic or office, there were three that indicated a traditional doctor.
The first record of modern medical services in Nigeria can be traced to the European expeditions of the early-to-mid-nineteenth century. It would be recalled that the explorations of Mungo Park and Richard Lander were seriously hampered by disease.
In the expedition of 1854, Dr. Baikie introduced the use of quinine, which greatly decreased mortality and morbidity among travelers. However, it is unknown whether the use of quinine by Dr. Baikie was his original discovery or whether he learned it from traditional herbalists with whom he had interacted in the course of his expeditions. Eventually, the use of quinine both as prophylaxis against and as therapy for malaria fever, expanded exploration, and trade.
Generally, the earliest form of Western-style health care in Nigeria was provided by doctors brought by explorers and traders to cater for their own wellbeing. Initially, these health services were not available to the indigenes. Eventually, the church missionaries began establishing health care services for people.
Missions like the Roman Catholic mission, the Church Missionary Society (Anglican) and the American Baptist Mission were at the forefront of the establishment of hospitals.
The first health care facility in the county was a dispensary which was opened in 1880 by the Church Missionary Society in Obosi, followed by others in Onitsha and Ibadan in 1886.
The first hospital in Nigeria was the Sacred Heart Hospital in Abeokuta which was built by the Roman Catholic Mission in 1885.
The health facilities were of high quality that and when the country gained Independence in 1960, these mission-owned hospitals were more than Government-owned hospitals.
Some of the high-quality hospitals at that time include the Seventh Day Adventist Hospital in Ilesha and the Wesley Guild Hospital in Ile-Ife which became the nucleus of the teaching Hospital complex of a major university in Nigeria.
The first government hospital in the country was the St. Margaret’s Hospital which was built in Calabar in 1889. After the establishment of St Margaret Hospital, several government-owned health care facilities were established, ranging from rural health centers to general hospitals.
By 1900, the provision of health services became centralized and Nigeria was merged with Gambia, Sierra Leone, and Ghana and controlled by the Colonial Office in London. This was the first centralization of control of health services in West Africa.
During this period, the Colonial Office determined the services that were available and provided the manpower. But 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, medical services developed and expanded with industrialization. Most medical doctors were civil servants, except for those working for missionary hospitals, who combined evangelical work with healing.
It was from the doctors in the civil service that the Chief Medical Officer was appointed. The CMO was the principal executor of health care policies in Nigeria and along with his several other junior colleagues (Senior Medical Officers and Medical Officers), they formed the nucleus of the Ministry of Health in Lagos.
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.
However, the Federal Government was responsible for most of the health budget of the States and the state governments were free to allocate the health care budget as they deemed fit.
Over the last five decades, the health care services in Nigeria have been characterized by short-term 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
- 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 years Strategic Plan from 2004-2008
These plans formulated goals for national health care services. 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 at that time and the aim was 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 mandated that 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 policy remained the major driver of healthcare delivery in the country.
When the Third National Development Plan was produced in 1975, more than 20 years after the report mentioned above, not much had been done to achieve the goals of the Nationwide Health Care Services policy. The conclusion was that this development plan seems to have focused attention on trying to improve the numerical strength of existing facilities rather than evolving a clear health care policy.
The Fourth National Development plan was in place between 1981 and 1985. It addressed the issue of preventive health services for the first time. The policy statement contained in this plan called for the implementation of the Basic Health Services Scheme (BHSS), which provides for the establishment of three levels of health care facilities; namely
1) Comprehensive Health Centers (CHC) to serve communities of more than 20, 000 people;
2) Primary Health Centers (PHC) to serve communities of 5000 to 20, 000 persons; and 3) Health Clinics (HC) to serve 2000 to 5000 persons.
The implication of this policy was that a CHC was expected to have at least 1 PHC in its catchment area and a PHC would have at least 1 HC in its catchment area. These institutions were to be built and operated by state and local governments with financial aid from the federal government. As a result of this policy, the provision of health services would be the joint responsibility of the federal, state and local governments.