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Tuesday, May 29, 2018

HEALTH MANPOWER TRAINING AND DEVELOPMENT


The need for manpower training and for the development of indigenous skills in health care services was recognized quite early, first by the missionaries and later by the colonial government. The main reason for this was the fact that the missionary physicians, as is true for other missionaries, had a high rate of morbidity and mortality among their ranks resulting from the inclement weather and previously unfamiliar tropical diseases. Since health care services had become a major part of evangelism, it became obvious that native Africans needed to be trained in all aspects of evangelical work, including health care delivery, in order to expand the missionary activities to the hinterland. The nearest place where this training was available was Britain. Several Africans were thus sponsored by missionary agencies to study in Britain. The first was John Macaulay Wilson, a Sierra Leonean, who became the first native African to become a physician. The first two Nigerian physicians were James Africanus Beal-Horton and William Broughton Davis, and they were similarly trained in Britain.[1],[4]
World War I brought the need for indigenous trained health care personnel home to the Colonial Government, which had hitherto mostly excluded Nigerian physicians from government medical services. The war led to the deployment of physicians and other health care workers in the army and there was an acute shortage of health personnel. Also, the influenza and plague epidemics had brought about the need for more hands. This led to the establishment in 1939 of the first medical school in Nigeria, the Yaba Medical College. At first, it trained medical assistants, but was later upgraded to train assistant medical officers. By special arrangement between the Colonial Office and The Royal Colleges of Surgeons and Physicians of Great Britain, most of the assistant medical officers were granted Licentiate Diplomas, after a short exposure in Britain.[5]
This made them full doctors. Sixty-two attended the Yaba Medical College, 56 graduated and 6 transferred to complete their training in Ibadan, when it was established in 1948. Of the 56 that graduated, 32 went to Britain under the arrangement with the Royal Colleges and the 24 left were upgraded to full physicians by the Nigerian government. Because the Yaba College trained only half doctors, it became quite unpopular with the emergence of political activism among Nigerians. It eventually disappeared with the establishment of the University College, Ibadan. Although the Yaba College was closed due to its unpopularity, another school for training incomplete doctors evolved in Kano (Northern Nigeria) in 1955. This was also short-lived and its graduates were mostly converted to full-fledged doctors by a political declaration.
Medical training in Nigeria's premier university, University College, Ibadan, was fashioned after the British system as would be expected. The pre-clinical work was done in Ibadan, the clinical work was done in Teaching Hospitals in England, and the degrees awarded were London University degrees. By 1957, all aspects of the training were done in Ibadan, but the degrees were still that of London University, whose officials conducted the examinations in Ibadan. It was not until 1967 (clearly 7 years after independence) that the University of Ibadan granted its own degrees. By this time, the University of Lagos had started awarding its own medical degrees. This was followed in quick succession by Ahmadu Bello University, University of Ife (now Obafemi Awolowo University), and the University of Benin. Other institutions followed, including the University of Nigeria, the University of Ilorin, the University of Calabar, the University of Port Harcourt, the University of Maiduguri, the University of Jos, and the University of Sokoto.
Today there are 26 medical schools in Nigeria, compared to 1 in 1960, 2 in 1965, 6 in 1975, 11 in 1984 and 18 in 2005, all providing medical education with curriculum borrowed from each other. Even our premier university and our revered seat of medical excellence, the University of Ibadan, College of Medicine, has not changed its curriculum since its inception. It has trained doctors in the same old way inherited from the British, as if the society is static. Even British Medical Education has changed many times over, yet ours remain the same. Fortunately, a change in medical curriculum is on its way in Ibadan and, to the best of my knowledge, will revolutionize the way we train our doctors.
Based on data from the Nigerian Medical and Dental Council, Nigerian medical schools graduate between 2000 and 3000 doctors annually. Established positions for doing the compulsory house-jobs (internship) range between 1000 and 1500, depending on available funds. What then happens to the 1000 to 1500 that cannot get internship positions?
The training of other health care professionals followed the same developmental process as that described for doctors with the early ones being trained in England, until the development of local schools. The training of nurses in Nigeria started after the establishment of the Nursing Council of Nigeria. The preliminary Training School (PTS) for nurses, which was based in Lagos, was transferred to Ibadan (capital of the West) as one of 3 such schools in the country. The others were in Kano (in the North) and Aba (in the East). Whereas the 2 schools in the South (Ibadan and Aba) had only a 6-month program, that in North (Kano) had 2 courses, one of them admitted students with lesser qualifications and the program lasted for 1 year, while the other program of 6 months duration was for students with a higher entry qualification. By 1954, 23 (all men) graduated from the Kano School, 40 (16 women and 24 men) graduated from the Aba School and 71 (42 women and 29 men) graduated from the Ibadan School.[3] As was the case with doctors, there was displeasure expressed over the incomplete training of nurses who received local training. This subsequently led to the establishment of 3-year nursing schools at designated government hospitals, 7 in the North, 6 in the East and 8 in the West. In addition, the Nursing Council granted recognition to 17 missionary built programs for training of full-fledged nurses and PTS nurses. By 1955 there were 100 female student nurses at the University College Hospital in Ibadan receiving British-type State registered Nurse's (SRN) training.

There were 2 cadres of midwifery schools in Nigeria. One trained Grade I Midwives and the other trained Grade II Midwives, the latter being a lower standard of entry qualifications and training. Grade I Midwives were trained in designated government centers and by 1954, 12 women had graduated from the Northern School in Kaduna, 23 from the Eastern School in Aba, 10 women from the other Eastern school in Calabar, and 20 women from both Massey Street, Lagos and Ade-Oyo Hospital, Ibadan in the West. Grade II midwives were trained in missionary hospitals or Native Authority (equivalent of present day local government area) facilities. These individuals worked mostly in rural areas and in 1954, 5 were trained in the North, 21 in the East and 103 in the West.
Public Health Attendants (known as Sanitary Inspectors) were trained in 4 schools of hygiene across the country. One school, operated by the Lagos Town Council Public Health Department, graduated 4 by 1954, while those operated by the government in Kano (North), Aba (East) and Ibadan (West) graduated a total of 128.[3]

The only schools for training Dispensary Attendants were in the North (Kano and Zaria). They became the centers for training Dispensary Attendants for the whole country, until the establishment of a similar training facility at the University College Hospital, Ibadan in 1957.The Field Unit School at Makurdi (in the Benue River in the North) began training of Sleeping Sickness Assistants in 1933 and later trained Medical Field Unit Assistants for the entire country. At the Oji River Settlement in the East, a 6-month course was established for training Leprosy Inspectors and Attendants. By 1954, 4 Leprosy Inspectors and 21 Attendants had been trained.3 Pharmacists were trained in the defunct Yaba Medical College site, and by 1954, 31 had graduated. The dispensers, trained at Zaria and Kano, were subsequently licensed to practice in Northern Nigeria only.
The only places that trained laboratory technicians were the Lagos Hospital and Kano Hospital and by 1954, 29 had graduate from Lagos and 2 from Kano. At the same time, 3 Dental Technical Assistants were trained in Lagos Hospital. The only school for Radiography was in Lagos and it trained x-ray assistants for the whole country. By 1957, a total of 10 had graduated from this school (5 from the West, 3 from the East and 2 from the North). The Orthopedic Hospital in Igbobi, Lagos, trained 6 Assistant Physiotherapists by 1957. This represented the training situation for personnel of the various aspects of health care services just before and around independence in 1960. After independence, the improvements were modest for the next 10 years, when judged against the background of population growth. For example, whereas there were 1354 physicians and 58 dentists in 1962, the corresponding figures for physicians and dentists in 1972 were 3112 and 124 respectively. However, the population growth from 54,000,000 in 1962 to 68,000,000 in 1972 makes the numerical improvement less meaningful.
The situation with nursing personnel was about the same. There were 7,107 registered nurses (RNs) and 6,917 registered midwives (RMs) in 1962, but by the 1972 figure had increased to 15,529 RNs and 16,034 RMs, thus reducing by one-half the nurse/ population ratio within 10 years. The training of all other cadres of health care personnel followed the same process of development. It is worth mentioning that before independence, we actually had more manpower training programs than we had at independence.
Nigerian Medical and Dental Council's recent data in 2002, lists about 22,000 physicians and about 1200 Dentists in Nigeria. This includes all those registered with the council. It includes all of the physicians in the Diaspora and those that have probably died. At the same time, the population of Nigeria has soared to about 130 Million. The Nursing Council of Nigerian data in 2002 named 49 recognized facilities for the training of nurses and midwives. The number of Nurses and Midwives are estimated as 62,000 for RN's (although 98,000 are listed in the Registry) and about 51,000 for RM's (although 75,000 are listed in the Registry). Even now an individual may train in one or the other. Most midwifery schools now admit only graduates of nursing schools. Once again, the training curriculum has not changed to reflect the realities of our society and advances in medical care. Today all of the teaching hospitals are now undertaking specialized nursing training, such as ophthalmic nursing, theater nursing, etc.
Public health attendants (Sanitary inspectors) have been eliminated completely. I am informed that some states are contemplating reinstituting them.

Dispensary attendants no longer exist. Sleeping sickness, although still a major problem in parts of our country, no specially trained attendants exist anymore. In our country's books, leprosy has been eradicated; but, is that really true?

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