At the turn of the century, medical services, as is the case with some other services, in Gambia, Sierra Leone, Ghana (then Gold Coast) and Nigeria were merged and controlled by the Colonial Office in London.This was the first centralization of control of health services in West Africa. The Colonial Office determined the services that were available and provided the manpower. 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 specifically, medical services developed and expanded with industrialization. Most medical doctors were civil servants, except those working for missionary hospitals, who combined evangelical work with healing. Among the civil service doctors, one was appointed the Chief Medical Officer, who became the principal executor of health care policies in Nigeria. Along with his several other junior colleagues (Senior Medical Officers and Medical Officers), they formed the nucleus of the Ministry of Health in Lagos. The details of centralized administration of health services up to this point are complex and they reflect the complex political transformation of the whole region. 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. Although the federal government was responsible for most of the health budget of the States, the state governments were free to allocate the health care budget as they deemed fit.