British Medical and Health Policies in West Africa C1920

BRITISH MEDICAL AND HEALTH POLICIES IN WEST AFRICA C1920 - 1960 BY FLORENCE EJOGHA NKWAM Thesis Submitted for the degree of Doctor of Philosophy in the University of London School of Oriental and African Studies 1988 ProQuest Number: 10672788 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 10672788 Published by ProQuest LLC(2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 Dedication To my husband and children ABSTRACT This thesis deals with the parts played by the Colonial Office and colonial governments in providing medical and health services in British West Africa. The themes addressed are: the provision of medical and health services; the organization of Colonial medical research; and the recruitment of medical officers. The inter-war period saw the development of a number of medical institutions established in government centres by the various colonial administrations. The provision of health care facilities in the rural areas was the responsibility of local authorities. During world war two, the Colonial Advisory Medical Committee produced for the first time a statement of policy on medicine and health for the Colonial Empire. This emphasised not only the provision of curative facilities but also the provision of preventive health care services. Apart from the provision of medical and health facilities, efforts were also made to stimulate interest in medical research. Medical research in British West Africa before WWII was carried out as part of the routine duties of Colonial Medical Departments. However, the Colonial Medical Research Committee, set up in 1945 by the Colonial Office, was to exert considerable influence on research policy in the region. The committee, which was dominated by the Medical Research Council favoured fundamental research. However, fundamental research was considered not relevant to the immediate needs of colonial i i i peoples. Instead, there was established a medical research organization, with emphasis on applied research and the investigation of the most prevalent diseases in West Africa. Meanwhile, between the wars, the Colonial Office tackled the problem of recruiting medical officers by creating the post of Chief Medical Adviser and by the amalgamation of the colonial medical services (CMS). Upto the outbreak of the war, however, the Office was still unable to meet the personnel requirements for the CMS. This problem was further aggravated with the creation in 1948, of the National Health Service. The end of WWII also saw an increase in international cooperation. United Nations specialised agencies such as the World H e a 1 t h Organization began to take an active interest in the health problems of African peoples. iv ABBREVIATIONS AMO: African Medical Officer ATMH: Annals of Tropical Medicine and Hygiene ATMP: Annals of Tropical Medicine and Parasitology BELRA: British Empire Leprosy Relief Association BMA: British Medical Association BMJ : British Medical Journal CDA: Colonial Development Act CD AC: Colonial Development Advisory Committee CDF: Colonial Development Fund. CAMC: Colonial Advisory Medical Committee CAMSC: Colonial Advisory Medical and Sanitary Committee CDPHC: Colonial Development Public Health Committee CD and WA: Colonial Development and Welfare Act CMA : Chief Medical Advisor CMRC: Colonial Medical Research Committee CMS : Colonial Medical Service CCTA: Commission de cooperation Technique pur 1 ’Af rique Cmd: Command paper CUP: Cambridge University Press FAO: Food and Agricultural Organization GMC: General Medical Council HMSO: His or Her Majesty’s Stationery Office IMS: Indian Medical Service INA: Ibadan National Archives IOPH: International Office of Public Health ISC: International Sanitary Convention IUP: Ibadan University Press JAH: Journal of African History v JTMH: Journal of Tropical Medicine and Hygiene LSTM: Liverpool School of Tropical Medicine LSHTM: London School of Hygiene and Tropical Medicine M.O. : Medical Officer MOH: Medical Officer of Health NHS : National Health Service ONA: Overseas Nursing Association OUP: Oxford University Press PRO: Public Record Office RAMC: Royal Army Medical Corps TDRF: Tropical Disease Research Fund TRSTMH: Transactions Royal Society of Tropical Medicine and Hygiene UNICEF: United Nations International Children’s Emergency Fund UNRRA: United Nations Relief and Rehabilitation Association WAACMR: West African Advisory Committee for Medical Research WAC: West African Council WACMR: West African Council for Medical Research WAMS: West African Medical Staff WHO: World Health Organization TABLE OF CONTENTS Page No. Title - Page i Dedicat ion i i Abstract i ii-iv List of Abbreviations v-vi Table of contents vi i-ix List of Maps x Preface xi-xvii i Acknowledgements \ »-/— x x Chapter One: The Provision of Medical and health services between the wars. 1 - 6 1 Major diseases Increased Intercommunication The impact of urbanization on public health The structure of the Administration and the provision of medical and health facilities African junior personnel The impact of the depression Chapter two. The Colonial Office and Medical Research in British West Africa, 1919 - 1939. 62 - 119 Introduction - Recognition of the problem The Colonial Medical Research Committee The Work of the Committee Medical Research in British West Africa Chapter Three. The Colonial Office and the problem of recruiting for the West African Medical services in "''the inter-war years 120 - 164 Results and methods of selection The schools of Tropical Medicine Recruitment for the West African Medical service between the wars The creation of the post of chief medical Adviser to the Secretary of state Unification of The Colonial Medical Services The recruitment of African Medical Officers Chapter four. The impact of world war two on recruitment for the colonial medical service in West Africa 165 - 203 War-time recruitment policy The NHS and recruitment for the CMS The recruitment of nurses The politics of Africanization Chapter five. Post-war development and planning for medical and health services in British West Africa 204 — 255 Introduc t ion Initiation of a forward policy The machinery for implementing development policy Development plans Training of medical personnel Chapter six. Post-war planning and the organization of medical research in British West Africa 256 - 318 The initiation of a research policy for the colonial empire The Colonial Office machinery for organizing research in the colonial empire The Colonial Research Service viii The Colonial Medical Research Committee and the organization of research for the Colonies Medical Research programmes in British West Africa Nutrition research Regional Coordination of medical research in West Africa Chapter Seven. International Collaboration in health work 319 - 373 Historical background Inter-Colonial Collaboration Anglo-French Cooperation in West Africa Inter-Colonial Collaboration and African nutrition The role of U.N. specialised Agencies in medical and health work in British West Africa International Cooperation on nutrition Chapter Eight. Conclusion 374 - 384 Bibliography 385 - 429 Appendix A. Provision of medical Institutions under Nigeria’s first ten-year development plan 430 - 434 Appendix B. Colonial Secretaries, 1919-1960 435 Appendix C. Govef-fvO^ of Nigeria, 1919-1960 436 Appendix D. Governors of the Gold Coast, 1920-1957 437 Appendix E. Governors of Sierra Leone, 1920-1961 438 Appendix F. Governors of the Gambia, 1920-1964 439 Appendix G. Biographical notes on some members of the Colonial Office Advisory Committees concerned with health and medicine in the colonial empire 440 - 445 ix List of Maps Map 1: Map of West Africa showing area of study (1935) Map 2: Map of Nigeria showing railway lines, 1930 Map 3: Map of Nigeria showing the provinces and major towns, 1930 Map 4: Gold Coast medical facilities, 1935 Map 5: Sierra Leone Medical facilities, 1935 x PREFACE The opportunity to undertake postgraduate research in African history presented itself in 1983 when I joined my husband, who was then undergoing his Fellowship training in surgery, in Britain. As a result, information for the thesis is based primarily on materials from British Archives. However, in October 1985, I undertook a brief visit to the Nigerian National Archives, Ibadan. The idea of doing a thesis on health and medicine in Africa was conceived in October 1983, during a discussion with Professor Gray, Head of the History Department, School OLAxi of Oriental^ African Studies. On reading a few of the A» available literature I discovered that there was still scope for research on various aspects of the subject. The study of health and medicine in Africa is a relatively new field of historical scholarship and consequently much of the literature has tended to concentrate on the outbreak of epidemic diseases and the epidemiology of endemic diseases. One approach to this kind of study had been to examine the relationship between changing human environments and the spread of diseases. There have also been localised

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