British Intervention on Health Services and its Effects on Okun-Yorubaland, Nigeria, 1900-1960

 Cite this article: Akanmidu, P. I. (2021). “British Intervention on Health Services and its Effects on Okun-Yorubaland, Nigeria, 1900-1960”. in Sokoto Journal of History Vol. 10. Pp. 80-88.

Paul, Ilesanmi Akanmidu

Federal University Oye-Ekiti; Ekiti State Nigeria Ilesanmi.paul@fuoye.edu.ng ; 2348060644300

This study evaluated the effects of British intervention on medical healthcare services on the British West Africa and its effects on Okun-Yorubaland around the Middle-belt of Nigeria. It argued that the British Government officially took over the administration of Nigeria in 1900. However, its administrative impact on social infrastructural development such as health sector, was nearly a tale of neglect up to the 1920s. This major deficiency is attributable to virulent epidemics and the outbreak of World War I, which characterized the British social engagements with her colonies in the opening decades of the twentieth century. This study uses historical approach to evaluate the exogenous and endogenous factors that caused inevitable change in the passivity of the British government to intervene on Nigeria‟s healthcare challenges. It synchronized the overlapping effects on the Okun-Yoruba people in Central Nigeria during the period of study.
Keywords: Nigeria, Okun-Yoruba, Health, Hospital, Disease, British, West Africa.

The sequential outbreak of Malaria, yellow fever and influenza in the opening decades of the twentieth century devastated the world generally (Gale, 1968). Virologists claimed that these diseases affected the demographic structure of the world at large during the period (Ohadike, 1991). The last of these diseases (influenza) coincided with the later period of World War I (1918-1919). We can sufficiently argue that the interplay of epidemics and the outbreak of the war left the world with two fold tragedies. Consequent upon the war, the global economy entered a serious phase of recession 1929-1932 (Brown, 1989). Thompson (2006) and Connelly (2006) have argued that the British government‘s involvement in the war was very central. This made the economy of Britain dwindle and eventually entered into a state of comatose. Thus, the financial stress during this period affected the global economy to the extent that most of the European countries found it extremely difficult to finance their colonies in Africa and Asia. In view of the general scenario, the activities of the British Government in Nigeria and elsewhere in Africa were at its lowest ebbs immediately after the war and through to 1930s as aftermath of the war and epidemics. The British health policy on its West African colonies as observed by Paul, (2015) was almost an absolute neglect. While it is plausible to generalize and attribute this fundamental negligence to the aftermath of the global outbreak of epidemic and war in one hand, on the other hand, it reflected the weakness of British political administration in West Africa. This becomes topical in the sense that the Francophone colonies in Africa were not neglected like the Anglophone countries and yet, France experienced the epidemic as well as involved in the war. It is on the strength of the above argument that we can strongly attribute the differential experiences and levels of social development in the Francophone and Anglophone countries to their policies. It would be recalled that the French policy of


assimilation was aimed at turning their Africa‘s subjects to french. This, unlike the Anglophone, which policy segregated against their colonial subjects (Thomas, 1980; Olukoju, 2003). Thus, whatever privileges accruable to a Frenchman in France, was thought worthy to be applicable to a French man in Dakar and other colonial territories elsewhere. This was however not the case in the Anglophone territories. A Briton saw himself absolutely special to a Nigerian and other people under its colonial territories. This had wider and lasting implications in terms of their socio- economic, political and health policies in their various territories. This study therefore, explores the scenario and the factors that motivated the British interventions on health and the implications on the Okun-Yoruba communities in Central Nigeria during the period of study.

Okun-Yoruba in View

Okun-Yoruba people constitute one of the groups that clustered around the confluence of rivers Niger and Benue in Nigeria. They are part of the people, Obayemi (1980) referred to as people in the Confluence Region in his study of Central Nigeria. This group was originally known as Kabba- Yoruba people. However, during the ethnographic study of Eva-Kraft Askari, a British ethnographer, he found and justified reasons he used Okun instead of the general Kabba for the people (Eva-Kraft, 1986). Thus, he became the earliest scholar that first used Okun, to denote the group under study here. He used the concept to identify as well as to classify them. The usage of the term was to strike a balance and to foster uniformity among the people. This people are sub-divided into five groups, namely: Iyagba, Ijumu, Owe, Bunu and Oworo. The use of Kabba as a general term over the generalissimo was beginning to cause disillusionment among other groups (Paul, 2016a). They perceived the term as means of a section of the group Owe (also known as Kabba) to lord it over other sub-groups. Askari must have encountered this challenge during his ethnographic field survey. In order to avoid unnecessary controversy, he decided to used a common expression, Okun-Yoruba to classify the groups and as a means of identification. Even though, each of the groups has its peculiar dialect, they are intelligible. Later, Obayemi, one of the leading scholars of Okun-Yoruba histories popularized the concept as an acceptable term for the purpose of group identification. Overtime, the concept became generally acceptable as a means of identification in a special sense to the groups under this study. Some scholars did not found the concept as a good replaceable expression to Kabba-Yoruba. In his argument, Onaiyekan (1975) wrote inter alia:

We find it hard to see how this eliminates confusion when it only introduces a new and unheard of expression to replace a term that had already become widely accepted, even though it may seem loosely used to foreign ethnographer who was out for precision at all cost.

Despite his arguments, subsequent Okun-Yoruba historians, such as Z.O. Apata, Y. Akinwumi and

I.   A. Paul among others have continued to use the expression to denote the groups under study during their historical survey of the people. However, it must be stated clearly, that even though we find the concept of Okun as a suitable term to identify this group of people. However, we need to exercise caution. This because the concept does not exist as a peculiar term to them. It is noteworthy that their neighboring groups such as Akoko-Yoruba, Ekiti-Yoruba and even Oyo-Yoruba, also used the term as a means of greeting (Akinwumi, 1992).

Background to Colonial Agitation for Better Amenities in British West Africa

Scholars such as, Flint, Ikime and Adeleye have argued that by 1900, the British colonial government had conquered Nigeria and had fully established its hegemony over the whole of its


regions (Flint, 1960; Adeleye, 1971; Ikime, 1977). In addition, the plan for its administrative structure was also gathering momentum. We have reasons to argue that between 1900 and 1906, the British government was busy consolidating its administrative structures with nothing tangible in place. However, 1907 till 1914 saw the beginning of administrative restructuring in Nigeria through the efforts of Frederick Lord Lugard (Lugard, 1922). This came to a climax in January 1914 when Frederic Lord Lugard (the first Nigerian Governor General) succeeded in amalgamating the North and Southern Protectorates. This major effort was considered a watershed and revolutionary in the political history of Nigeria. It would indeed, have been a great achievement for Nigeria but the outbreak of World War I (1914-18) did not allow it to translate to social development. A critical assessment of Nigeria during this period shows that, there was no major impact of Colonial legacy that reflects significantly on Nigeria‘s social development and at large on other British colonial territories in West Africa as a whole (Conklin, 1997).

It was this major observable loophole that triggered the idea of comparism between the British and French territories in West Africa. For example, while dispensaries, hospitals and other social amenities were built in all the communes in French colonies, the facilities were meant for all its citizens without specific marks of differentiation (August, 1985). This was however not the same in the British territories. Social amenities were provided for the British officials who lived differently in the Government Reserved Areas (GRA) while others lived in segregated areas where there was no serious attention for the provision of social amenities. However, the contiguous geographical locations of French and British territories in West Africa sub-region began to cause basis for comparism among the educated elite (Garba, 2019). It was widely circulated through propaganda in the available newspapers in the British West Africa during the period that people in the French colonies enjoyed better amenities than their British counterparts (Agboola, 2019). It was also added specifically that the British lacked better health policies for its territories (Ogunremi, 2019). These arguments were strongly peddled by the educated elements who were alienated from the British Administration. Most of these accusations also warranted the early decolonization process in British West Africa. The Educated elites maintained hard-lines and consistent arguments of neglect especially on healthcare matters (Paul, 2016b). The medium of popularization of idea and consistency on this matter by the educated elites made it extremely difficult to be ignored by the British government. Thus, the British Secretary of State, proposed the possibility of constituting advisory bodies to investigate the veracity of the reality of this popular opinion; that French West African territories were much developed than the British territories of West Africa. These bodies were also to make recommendations on how social amenities especially on health matters could be improved across its territories in West Africa.

Advisory Bodies to the British Government and Reports

Toward the end of 1920s, the British Government took dramatic steps to improve the general condition of its West African colonies. This was as a result of the agitation of the educated elite who after their returns from abroad to Nigeria were dissatisfied with the general level of development and segregation between the British officials and the Nigerians. They were eager to see the impact of British administration on their various communities. In reaction to the various agitations through newspapers, the British Government appointed Dr. A.T. Stanton to advice the Secretary of State on the Medical and Sanitary matters in the colonies and also introduced new innovation that would improve the general condition of the Colonial medical services (NAI, 1926). Secondly, it sent Under Secretary of State for the colonies, W.G.A. Ormby Gore, on tour of West African colonies in order to survey the state of socio-economic development programmes including medical and healthcare


services (NAI, 1928). At the end of these exercises, Ormby observed that, medical and healthcare services in Nigeria was far behind and could not be compared with French territories in neighboring West African colonies he had visited. He strongly advised the government to provide adequate medical services for the entire native population, unlike in the past when it concerned itself with services to Europeans and native officials. In addition, he recommended the training of indigenous dispensers, dressers, midwives and welfare workers to undertake medical and healthcare services within their ethnic groups. The above recommendations became plausible in the face of insufficient European personnel and the need to co-opt the natives in the healthcare services within their domain (Schram, 1970). Barely two years later after this recommendation, Dr Stanton toured West African colonies to survey primarily the medical and healthcare facilities. His report complemented the previous report of Ormby Gore. He also recommended the expansion of healthcare services across West African colonial territories. These two official reports were very significant in the historical revolution on healthcare services in British West African territories. In the first instance, it emboldened the Government of Ramsay MacDonald, which came to power in 1929 to pass the colonial Development Act of 1929 providing a grant of One Million (1, 000.000) pounds to support Nigerian‘s Annual Budget of 1930 (Phillipson, 1947). This development coincided with Governor Thomas‘s Local Government Reforms in Nigeria, which aimed at the institutionalization of Native Authority (N.A) in the country to undertake the establishment of social services and resulted in the institution of medical and health facilities including dispensary, sanitary and child welfare services among others.

The Native Authority (N.A) Dispensaries

Following the recommendation of Ormby Gore and Stanton, the Colonial Government started discussions on the possibilities of expanding health facilities to rural communities. At the Resident Conference of 1929, they endorsed the recommendation of the expansion for the network of dispensaries and the training of Dispensers and other health workers (Paul, 2018). They however, scheduled the official training of the scheme of N.A dispensaries for 1930. Consequently, the Provincial Authorities in Kabba Province proposed to build dispensaries in the Districts such as, Kabba, Ikare, Okene, Koton Karfi etc, while she also proposed out-station posts to these adjoining settlements of the District headquarters in preparation for the launching of the scheme. As planned, the Colonial Administration launched the scheme of N.A Dispensary in 1930 but almost all the construction of the proposed building were still in the process of construction at the time the scheme was launched. By April 1931, N.A. Dispensary building in Kabba was completed and launched. Another key programme in the scheme was Out-station post mechanism. This method was proposed for consideration because of the wide geographical sphere and scattered settlements around the confluence region. Out-station plan was thought to be plausible to cater for minor cases of health issues in different locations outside the Provincial Headquarters. Whereas, serious cases encountered from the out-station posts were to be referred to the Province for intense medical attention. Unfortunately, the proposed out-station programme could not be realized due to certain factors. In the first instance, shortage of medical personnel was critical. During this period, the European medical personnel available were very few in number (Paul, ibid). It was partly for this reason; it was considered that the best way to overcome the challenge of insufficient medical personnel was to train the natives as dispensers, midwives and welfare workers.

It is imperative to stress here that the challenge of medical personnel was the underlining factor that prompted the consideration of the training of the native population by British Colonial Officers (African Mail, 1913). Hitherto, the natives under normal circumstances were considered as weak


and lacking the sophisticated intelligence for such rigorous assignments (Paul, 2016b). Secondly, financial constraint jeopardized the plan. Maintaining out-station programme required heavy financial commitment. It required building more structures, hiring more medical personnel and paying the salaries of the health workers in the out-stations. However, the outbreak of the global economic depression of 1929 to 1931 hindered all the measures put in place towards the realization of the plan. Alternatively, the Native administration considered Mobile Clinic in place of out-station posts (Arogundade, 2018) The Provincial Government in collaboration with the District Officer (DO) embarked on Mobile Clinic strategy. The Mobile Clinic Officials moved around the communities with NA Medical Van periodically to treat as well as to inoculate people against epidemics diseases (Ajibade, 2018). Each of the communities has it days in the month in which the Mobile Officials with the N.A van visited. Usually, the people in the community would gather at a designated venue to be treated by the medical officials. Serious cases were referred to the Provincial Dispensary in Kabba for medical attention. In some cases, where there were complications that could not be handled in Kabba, such were referred to Government Hospital in Lokoja. Other major constraint of this pattern was; the periodic visit of the mobile clinic officials could not guarantee health stability for the local population in the rural areas. Between the periods when the clinic officials were not available, the lives of the rural dwellers were literarily exposed to danger.

This strategy, even though achieved appreciable results to some extent, the Provincial Government had to review the previous methods. One of the giant steps taken to combat the problem of personnel was to recruit indigenous people through the Province and District and sent them for training in Kaduna, Makurdi, Lokoja, and Enugu for some months after which they were posted to different centers as, dispensers, dressers, midwives and leprosy and sanitary officers (Paul, 2018). The section to which individual belonged was determined during the period of their training. Some were sent to London, Canada, United State of America for their training. After the completion of their trainings, the trainees were placed under the direct supervision of District Officers (D.O), who gave instruction and direction of their activities (ARDMSS, 1932). As part of their roles and functions, the Sanitary Inspectors ensured people conformed to specific standards that enhanced good health of the people. They watched over surrounding of homes to ensure the communities were kept clean in order to prevent disease vectors such as mosquitoes. It should be noted that during the period of study, modern latrines were not common among the people. Everybody went to the forest/bush to defecate (Otitonaiye, 2018). However, there were possibilities for under age children to defecate indiscriminately. Thus, as part of the responsibilities of sanitary officers, they were to ensure the surroundings of the people were kept clean. Later, pit latrines were introduced. At the inception of this idea, pits were dug to the depth of between 10 and 12 feet down and strong slabs of woods were used to cover it. A round or square hole was created through which people passed their faeces. As part of their responsibilities, the sanitary officers were to ensure rivers or streams where the communities fetched water for domestic purposes were kept clean especially during the dry season (NAK, 1933). They equally served as advisers to the village heads who were in charge of public utilities such as market square. Food and meat sold were scrutinized to ensure high quality food materials and meats free from contamination were sold to the general public. Animals such as goat, cow, ram etc that were slaughtered for commercial purposes in the abattoirs were inspected to ensure that they were free from any form of infectious diseases that could endanger the lives of the masses (NAK, 1936). Animals that were not inspected by the Sanitary Inspectors were not allowed to be sold for public consumption (Paul, 2018). Government empowered the Sanitary Officers to prosecute the violators of the above offences. Violators were


fined heavily, which ultimately made them feared by the general public. With this development, Okun-Yoruba communities were kept clean.

The Dispensers on the other hands were like the modern day medical doctors. They were stationed in the established dispensaries to take care of the people with diverse health challenges. They treated people with snake bites, malaria, skin and water borne diseases (Paul, ibid). They administered drugs to the people and taught them how they were used. From 1900 up till 1930s, there was no full-fledged government hospital in Kabba Division. Ilorin and Lokoja, which were the nearest were one hundred and twenty (120) and fifty-three (53) kilometers respectively from Kabba town, which was the headquarters of Kabba Division. There were instances, during which people with serious health cases died in the process of transporting them from Okun-Yorubaland to either Lokoja or Ilorin (Olorungbeni, 2019). In addition, there were also transport difficulties. During the period under study, only few vehicles were available for transportation of people from one location to the other. Thus, the combination of distance and transportation difficulties constituted a major difficulty to healthcare delivery to the people. This explains why the Dispensary in Kabba served a useful purpose. It received a large turnout of patients who were seeking for healthcare attention but who could not travel to Ilorin and Lokoja (Olorungbeni, ibid). Apart from attending to medical cases, the dispensary also served as center for vaccination.

The construction of dispensary center in Kabba initially satisfied the aspiration of the Okun-Yoruba educated elite. This was because; it served the interests of large number of educated elite who had moved to rural areas as teachers, N.A officials and missions‘ workers (Paul, 2016c). It is worthy of note that these educated elite were instrumental to the idea of establishing modern medical health facilities from the opening decade of the twentieth century across Nigeria. Thus, the establishment of the Provincial Dispensary in Kabba was to the educated elite, a fulfillment of purpose. The commissioning of the Dispensary in 1931 was greeted with fanfare and pageantry. Within a year of its commissioning, it attended to an average population of 11, 686 patients (Paul, 2015). It was further reported that the new facilities could hardly meet the needs of the high number of patients that were coming for treatments. However, it is important to mention here that the high number of people recorded was largely as a result of free treatments of patients, which was the initial policy of the maternity when it was established. Secondly, we can also advance further that it was an indication of appreciation of western medicine over traditional medicine, which the people had used before the introduction of western medicine.

However, the subsequent development on the maternity took dramatic turns in 1937, when the Provincial government introduced another policy of payment for treatments administered on the patients (Paul, ibid). The introduction of this policy was due largely to inadequate financial resources to meet the needs of the large number of patients who were patronizing the dispensary. The financial needs of the maternity became astronomically increased because of the necessity for more drug supply, payment of medical personnel and other overhead costs of running and maintaining the dispensary. The Provincial Government thought it would be financially helpful if the patients were made to pay part of the treatments administered on them by the medical personnel. Provincial Authority introduced a fee of one penny for every dose of medicine and three pens for every wound or disease treated to a conclusion. Only government and Native Authority workers and school children were exempted. This was considered beneficial for the survival of the maternity as the purported amount accruable from the payment was planned to supplement part of the huge financial needs of the maternity. However, the introduction of the policy discouraged majority of


the people to the extent that appreciable number of people abandoned the maternity. This became manifested vividly in the number of patronage. There was a shortfall of over 50% of previous year‘s attendance. People were disillusioned about the introduction of fee charges. Other people started to patronize the traditional medical practitioners for their health wellbeing.


This study has evaluated the British intervention on healthcare delivery with attention on the Okun- Yoruba people in the confluence region of Nigeria. The study shows that 1900 marked the official takeover of Nigeria by the British government. Even though officially, Nigeria was proclaimed the British colony, the British could not do much to justify positive social infrastructural development because of the challenges of the virulent epidemic and the outbreak of World War I between 1900 and 1920s. In this study, it was argued that between 1900 and 1906, British government was still battling with struggles of consolidation. Thus, great achievement occurred between 1906 and 1914, with the amalgamation of southern and Northern protectorates of Nigeria. However, with the outbreak of World War I, in 1914, the British government was bogged down with the war in Europe and she was financially distressed. The seemingly abandonment coupled with the alienation of the Nigerian educated elite triggered agitations and petitions through comparative policies of Francophone and Anglophone in West Africa. The British government did not respond to the agitation of the educated elite until the late 1920s. This necessitated the constitution of Dr. A.T. Stanton in 1926 and the other W.G.A. Ormby Gore in 1929 both were to survey the levels of social amenities in Nigeria and British West Africa respectively and make recommendations for improvements. The two reports berated the level of healthcare services in Nigeria and British West Africa. It was these reports that fired the government of Ramsay MacDonald of 1929 to approve a grant to the tunes of One Million Pounds for the upgrading of social amenities especially medical health facilities in British West Africa. This development facilitated the establishment of Health and Sanitation Department. This development facilitated the preventive and curative approaches. In Okun-Yorubaland, it enhanced the recruitment of potentials out of the native population who were trained as Dispensers, Sanitary officers, Maternity Officers. These officers were empowered by the Districts Officers (DO) to bring violators to book. The activities of these locals helped Okun- Yorubaland. In the first instance, they served as educators or trainers to the general populace of Okun-Yoruba people. Secondly, they ensured the local population kept to basic rules of environmental hygiene. Between 1920 and 1960, these officers were fully in charge of medical healthcare in Okun-Yorubaland. They enforced healthcare related laws and the deviances were punished accordingly within the armpit of the law. The Mobile clinic, which was put in place to lessen medical complications among the rural population in Okun-Yorubaland helped in no small measure within the period of study.



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Paul, I.A. (2015), ―A History of Healthcare Services in Okun-Yorubaland, 1800-1900‖ An Unpublished Ph.D Thesis, Department of History and International Studies, University of Ilorin, Kwar State, Nigeria

Paul I.A (2016a)  ―The  Migration  Pattern  and  Identity  of  the  Okun-Yoruba  People  of  Central Nigeria‖ Yoruba Studies ReviewsUSA, 1, (1):105-121

Paul I.A.  (2016b),  The  British  Colonial  Healt Polic in  Nigeri during  Frederic  Lord  Lugard Administration, 1900-1919‖ Contemporary Humanities, School of Education and Humanities, Babcock University Ilishan-Remo Ogun State, Nigeria, 9, (1): 86-102

Paul, T. (2018), Personal Interview, Kabba, Kogi State, Nigeria

Phillipson, S. (1947), Administrative and Financial Procedure under the New Constitution between Government of Nigeria and the Native Administration. Lagos: Government Printers, pp.54- 55

Schram, R. (1970), A History of Nigerian Health Services, 1971, Ibadan: Ibadan University Press, pp. 313-315

Thomas, S. G. (1980), Segregation in the British West Africa (La segregation en Afrique occidentale britanique) Cashiers dEtudes Afrcaines, (20), 80

Thompson, A.O. (2006), Economic Parasitism: European Rule in West Africa, 1880-1960, Barbados:   University   of   the   West   Indies   Press;   Connelly,   M.   (2006)   ―The   New Imperialists,‖ in craig Calhoun et al (eds) Lessons of Empire: Imperial Histories and American Power, New York: New Press, pp. 19-33.

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