Wellcome Trust History of Medicine PhD Studentship: Further Details
Health systems and Development: the case of Nigeria 1946-c.2000
This studentship is part of a larger Wellcome Trust Investigator Award which examines the
intellectual and policy history of health systems thinking. The framework below has been set
out to ensure that this PhD project contributes to the overarching aims of the award. Within
this framework however, the successful candidate will have the opportunity to develop the
project in ways which interest them.
Title: Health systems and development: the case of Nigeria 1946-c.2000.
Aim: to examine the context and impact of health system-level plans or policy decisions for
Nigeria since the late-colonial period
Objectives:
a. Identify and describe the content of development plans or policy decisions about the Nigerian
health system made by
•
the colonial or national government, and its regional and federal arms
•
international organisations, such as WHO and UNICEF
b. Examine the formation and outcomes of these plans/policy decisions in the context of
Nigeria’s broader economic and political history (e.g. oil price shocks, federal state creation, civil
conflict)
c. Analyse the influence on these plans/policy decisions of changing ideas about health systems,
whether articulated from
•
colonial/Western positions or
•
post-colonial/African nationalist positions
d. Analyse the extent of system adaptation that resulted from these plans/policy decisions with
respect to:
•
health system financing
•
centralisation or devolution of power and resources
•
character of medical care (hospital, preventive, community, indigenous provision)
Context
Since the end of World War Two, international development has been conceived in relation to
issues of resource access and poverty; governance, equity and representation; and flows of
capital, investment and debt. This has had important ramifications for state capacity in
planning, and indeed for the role of the state itself, in the context of decolonisation,
independence movements and aspirations, and structural constraints on capital investment and
the expansion of the state. These contexts test, challenge and condition the power of health
systems thinking to shape and prescribe policy, analyse needs and outcomes, and describe ideal
circumstances, institutional formations, norms and mechanisms for the delivery of health.
Nigeria, Africa’s most populous nation-state, and the world’s eighth largest oil producer,
provides a rich and valuable historical case for the consideration of these issues. In spite of its
abundant human capital and mineral wealth, its health indicators are relatively poor in
comparison with other developing economies. Recent histories of the control of malaria, polio
and Ebola virus disease tell contrasting stories, illustrating strengths as well as weaknesses in
the health sector and its ability to mobilise planning, material and human resources.
This project interrogates the historical roots of state policy on health care provision in Nigeria,
paying attention to both its dynamic potential and its systemic weakness, thereby constructing a
case which illuminates the development of health systems thinking and policy in a global
perspective.
Programme
Nigeria has had a large and highly differentiated civil service since the 1940s. Welfare and
health planning has been subject to a variety of centralising and regionalising tendencies,
relating to the much vaunted ‘federal character’ of the post-colonial state, an inheritance of
colonial patterns of spatial, social, and ethnic differentiation.
A highly developed tertiary education sector has fed into professionalised civil and military
bureaucracies, to a critical and vociferous press, and to an established scholarly critical
literature on health and welfare planning. Consequently, the framing, critique and
documentation of state planning has been extensive.
The post-colonial history of Nigeria has also been subject to repeated political shocks and
extensive disruption. This has had a strong impact on state capacity in health care and health
planning. Furthermore, pressures of reorganisation, of patronage and competition, and of
conflict and destruction, have all shaped the outcomes of planning processes, and of their
documentation.
The studentship holder will be expected to identify and critically evaluate relevant Nigerian and
comparative scholarly literature in the humanities and social sciences, trace published and
archival documentation through a variety of state, ministerial, university and non-governmental
repositories, and to complement this process of scholarly critique and information retrieval
with oral historical testimony from key informants. Support and supervision will be available to
assist in framing and executing this work programme.