Journal of Social Development in Africa (1992), 7,1,45-65 
Health Services and Military Messianism 
in Nigeria (1983-1990) 
SOGOHALUBCT 
ABSTRACT 
Since the 1983 military coup in Nigeria health services have been declared a major 
priority of the military regime. This health priority, along with professed 
commitments to popular welfare and to the resolution of economic problems, 
constitutes the declared raison d'etre for intervention. Rather than being a 
solution, the various reforms which are integral to the overall economic austerity 
programme have, however, escalated the crisis situation in health care. Aside from 
the increasing incidence of nutritional disorders directly traceable to the austerity 
measures, there is more exclusion of the majority from available medical services 
on the one hand, while privileges such as overseas treatment at public expense 
continue for top government officials on the other. These obvious contradictions 
between professed commitment and actual practice are explained against the wider 
dynamics of economic crisis and attendant adjustments. 
Introduction 
Until recently, health care in Nigeria has been conceived in official policy 
documents as apolitical and autonomous, without links to the wider society. The 
political nature of health care now seems to be recognised, at least since the 1983 
military coup d'etat This intervention was ostensibly necessitated by the fact that 
"Health Services are in shambles as our hospitals are reduced to mere consulting 
clinics without drugs, water and equipment" (Abacha in Iroha, 1984: 3-4). 
Since the coup there have been several other indications of the political nature 
of health care and its links to the wider political economy. The campaigns for the 
removal of the petrol subsidy in 1986/87, for instance, mentioned availability of 
drugs as a benefit to be derived from this. Indeed, the entire austerity programme 
and the raison d' etre of military rule are now legitimised by pointing to supposed 
improvements in health services1. 
+ Department of Sociology, University of Jos, PMB 2084, Jos, Nigeria.
46 S OgohAIubo 
Given this declared priority of health care, it is appropriate to examine the 
health programmeof the military. What, for instance, are its programmes to change 
the 'consulting clinic' status of public hospitals, and stem the health care crisis in 
general? Would these policies actually stem the tide? 
It is to these and related issues that this paper, which focuses on the post 1983 
coup, is addressed. The role of the military in post colonial Nigeria is discussed, 
and the health policies and practices of the military are examined. These 
developments in health care are then explained in terms of the overall economic 
crisis within which the former can be more fully interpreted and understood. The 
true nature of military messianism is sketched in the conclusion. 
The military in post colonial Nigeria 
Nigeria, a former British colony, gained independence in 1960. Since attaining 
independence, the country has experienced frequent political turbulence manifest 
particularly by regular military interventions. The military has ruled the country 
for all but 10 years of the 30 years of independence. It is therefore possible to 
classify Nigeria's post colonial polity into the First Republic (1960-66), military 
rule (1966-79), Second Republic (1979-83), and military rule (1983-date). The 
coups are explained by the unconstitutional role the military has arrogated to itself 
as messiahs and political watchdogs. Beyond matters of defence and warfare, the 
military in Nigeria now constitute the de facto rulers. 
Military messianism is a term which refers to the articulation of unemployment, 
inflation and other problems of Nigeria'spolitical economy in terms of corruption, 
ineffectiveness and similar vices, particularly under democratic rule, and the 
position that military intervention would resolve these problems. In other words, 
military intervention is presented as a messianic initiative to save the country and 
its people from hardship. Since Africa's first military coup d'etat took place in 
Sudan in 1958, the military has in various countries arrogated this messianic role 
to itself, in thepreformanceof which ithas periodically ousted elected governments 
(Cervenka, 1990; Jenkins and Kposowa, 1990). 
What is perhaps the most erudite articulation of military messianism in Nigeria 
was recently provided by General Babangida, the current ruler (in Barrett, 
1990:213): 
"The military has been forced into governance primarily and principally by 
the necessity to secure the foundation of our polity from collapse. The 
option was not a choice between shoring up one coalition of civilian rivals 
against the opposition of another, but in ensuring we did not dissolve into 
anarchy. Our intervention remains justifiable by the imperatives of securing
Health Services and Military Messianism 47 
the wholeness and oneness of our economy and nation. If we really 
understand the implications of the roles of the military in our national 
agenda - then we can truly appreciate the full significance of the contribution 
of the military to our survival as a nation. Those who quarrel about how to 
share the rooms of a house, the foundation of which is collapsing, can only 
with extreme charity be condemned for lack of wisdom." 
However, military messianism in Africa primarily emphasises structural 
reforms rather than system or revolutionary change. These reforms are ostensibly 
non ideological. Class contradictions and related problems of Nigeria's market 
economy are either completely denied or explained as teething problems of 
development to be overcome by more effective government As this paper will 
show, military messianism is perhaps the most important single factor shaping the 
form, content and process of Nigeria's post colonial polity. 
At independence, a parliamentary democracy headed by Tafawa Balewa, 
which succeeded the colonial masters, was terminated by a military putsch in 
January 1966. Accordingtothemilitary.thegovernmentwascorruptandineptand 
misrule had brought the country to the brink of an economic and political precipice. 
Politically, there were several disturbances in the 1960-66 period, including the 
constitutional crisis in the Western Region and the Tiv riots. In the former case, 
the regional premier was removed by democratic process but refused to quit His 
action led to violence and riots and the Federal Government had to intervene. A 
state of emergency was declared in the region and an administrator appointed. 
However, the constitutional power of the Federal Government to intervene was 
challenged (Ojiako, 1981). Similarly, rivalry between supporters of two political 
parlies resulted in major riots among the Tiv during the period. 
These upheavals were in addition to widespread nepotism, tribalism and 
"alleged attempts by (the) Ibos to dominate other ethnic groups" (Ojiako, 1981:179). 
For the military, therefore, a timely intervention was necessary to save the country 
(Mainasara, 1982; Ademoyega, 1987; Muffet, 1982). 
The 1966 intervention led by the late General Ironsi marked the beginning of 
what has turned out to be a series of coups, counter coups and coup attempts. The 
Ironsi ascendancy was, however, perceived by a large section of military as part of 
the Ibo domination. General Ironsi was assassinated six months later and Colonel 
Gowon took over as head of state. After the countercoup, the Ibos attempted to 
secede from Nigeria to regroup as Biafra in what was hitherto the Eastern region. 
These events culminated in a civil war between the Biafran seccesionists and the 
Federal Government in the 1967-1970 period (Ojiako 1981; Muffet 1982). Gowan 
prosecuted the civil war (1967-1970), and was himself overthrown in 1975 by 
General Mohammed. The main reasons given for the coup were indecision, 
corruption and ineptitude. General Mohammed was assassinated in a coup attempt
48 S OgokAJubo 
in 1976 and was succeeded by his deputy, General Obasanjo. It was General 
Obasanjo who presided over the transition to democratic polity in 1979. 
Both Gowon and Obasanjo's regimes were periods of enormous oil wealth. 
Indeed, the slogan 'money is not the problem but how to spend it' became the 
rallying cry during this period. The oil boom was, however, short lived as a decline 
in oil revenue, first manifest during Obasanjo's regime, soon led to a fiscal crisis 
(Abba et al, 1985; Onimode, 1983). 
The Second Republic, as the civil rule between 1979 and 1983 is called, was 
modelled after the US presidential system and presided over by Shehu Shagari of 
the National Party of Nigeria. Economically, oil revenues improved in the first two 
years of this second democratic experiment. This boom was also ephemeral, as a 
major crisis manifest in high unemployment, unpaid salaries, particularly in the 
public service, low capacity utilisation, deterioration in social services and 
accompanying frustration, became ubiquitous (Madunagu, 1984; Forrest, 1986). 
The crisis, it could be argued, set the stage for the military coup of December 
1983. Hence the coup led by General Abacha received broad based popular 
support. According to the military "in [the] discharge of our national role as the 
promoters and protectors of our national interest" intervention was a patriotic 
imperative to save Nigeria from "grave economic predicament and uncertainty" as 
well as from "harsh intolerable conditions" (Abacha in Iroha, 1984:4). In General 
Buhari's more trenchant words, the coup was (in Iroha 1984:6-8): 
"In pursuance of the primary objectives of saving our great country from total 
collapse.... The change became necessary in order to put an end to the 
serious economic predicament and the crisis of confidence now afflicting 
our nation." 
The Buhari regime tackled these problems with military resolve in which many 
of its 'solutions' contradicted earlier declarations. Rather than provide jobs, for 
instance, people were retrenched en masse. Similarly, increases in taxes fuelled 
inflation, and the reintroduction of hospital and school fees abolished during the 
oil boom restricted access to hospitals and schools (Alubo, 1985a). 
Opposition to these policies was suppressed through arrests, detention without 
trial and the proscription of 'troublesome' organisations. As Bangura has 
indicated (1987), Buhari's was a regime of creeping fascism. 
General Buhari was overthrown in a palace coup led by General Babangida, 
hitherto Chief of Army Staff. Again, General Abacha, who announced the 
overthrow of Shagari and held a key position in the Buhari government, remarked 
that (in Newswatch, 1985, September 7:9): 
"The deplorable state of our hospitals and increasing deterioration of our 
health care delivery, the unemployment of our citizens especially graduates 
has reached alarming levels."
Health Services and Military Messianism 49 
In other words, military rule was yet to bring any redemption. 
President Babangida's first speech was strewn with the same rhetoric as 
General Buhari's, now a villain. Like the latter's remarks about deposed President 
Shagari, Babangida observed that (in Newswatch, 1985, September 7:9): 
"The last twenty months have not witnessed any significant changes... 
contrary to expectations, we have so far been subjected to a steady 
deterioration in the general standard of living; and intolerable suffering of 
the ordinary Nigerians have risen higher... hospitals still remain mere 
consulting clinics. While educational institutions are on the brink of decay. 
Unemployment has stretched to critical dimensions." 
This strident condemnation notwithstanding, the economic policies of the two 
regimes, and indeed those of the deposed civilian government, differ only in form 
rather than in essence. All of them were primarily informed by monetarism-supply 
side economics (Bangura, 1987). 
During the last two years of the civilian government, negotiation for a $2,5 
billion IMF support loan was initiated. The negotiations were, however, stalled 
because of the anticipated political costs of the conditionality (devaluation, 
withdrawal of subsidies and trade liberalisation) the IMF demanded. Rather than 
bow to these pressures, the government chose fiscal measures to conserve foreign 
exchange (Forrest, 1986). 
The negotiations with the IMF continued during the 20 months of the Buhari 
government. Again, theconditionality, particularly devaluation, was resisted. The 
government continued the fiscal measures of its predecessor, in addition to counter 
trade, ie the direct exchange of oil for various commodities. Counter trade was, 
however, frowned upon by Western creditors, including the IMF and World Bank, 
whose support the government needed to maintain credit facilities (Bangura, 1987). 
The Babangida regime has now changed this situation. Irrespective of the 
popular rejection of the IMF loan in a national debate, the government has 
surreptitiously taken the loan. Since 1986, Nigeria has been implementing an IMF 
World Bank prescribed austerity programme. Accordingly, the currency has been 
devalued through public auction by over 500 percent, while subsidies on petroleum, 
fertiliser and other products have been lifted. 
The Babangida government, however, denies that it is implementing any IMF 
or World Bank programme. It insists that the austerity programmes are home 
grown. This ability of the government to successfully manipulate the Nigerian 
people has earned Babangida the soubriquet 'Maradona of Nigeria', after the 
Argentinian soccer star Diego Maradona famous for dribbling. 
The economic policies of the Babangida regime (as detailed below) has led to 
major confrontations with the populace, including two popular uprisings (Alubo, 
1989). Besides intensifying monetarist measures, the continuity between Buhari
50 S OgohMubo 
and Babangida also extends to other areas such as detentions without trial, 
proscription of associations thought to oppose government, and the general 
suppression of dissent (Sagay, 1988; Alubo, 1990a). 
Therefore, it seems clear that a wide gulf exists between the rhetoric and 
realities of military messianism. Indeed, this messianic posturing, now a topic of 
intense debate (see Ayu, 1985; Beckman, 1987), has been increasingly called into 
question. Many have argued (Amuo, 1989; Szentfel, 1989; Ayu, 1985) that rather 
than redemption, military dictatorships only militarise class struggle as well as 
escalate human rights violations. 
Clearly, the experiences in Nigeria lend little credence to any messianic image. 
The hope and promises for a glorious dawn in the country, as the health reforms 
discussed below reveal, continue to have a hollow ring. 
We conclude this section by noting that there was a coup attempt in April 1990. 
Like other interventions, the reasons for the unsuccessful attempt were replete with 
familiar rhetoric: corruption, deteriorating economic conditions and oppression of 
the citizens2. Also, there is a phased programme of transition to civil rule which 
will fully mature in 1992 (Alubo, 1989; Agbese, 1990). 
Health reforms under the military (1983-1990) 
Before we turn to the various health reforms of the military, it is germane to outline 
the main features of the Nigerian health care system. Health care in Nigeria is 
largely limited to Western biomedicine (Erinosho, 1982) which is available from 
three parallel sources: voluntary agencies, private medical enterprises and the 
public sector. 
Voluntary agencies (Vola) 
Voluntary agency, as religious and non profit organisations are called, medical 
services predate the formal colonisation of Nigeria by almost a decade (Schram, 
1971). Several Christian missionary organisations were involved in these medical 
activities, the major ones were the Church Missionary Society, Baptist Mission and 
Catholic Church. In addition to providing medical care, these missionaries also 
trained Nigerians in their home countries. Through this process, the majority of 
Nigerians who had early Western education, including medical education, trained 
abroad and usually became Christians. Vola activities were subsidised both by 
Nigeria's colonial and independent governments (Alubo, 1983). We must, however, 
note that medical care was essentially an instrument for evangelism, a process in 
which it was, as in other underdeveloped countries, a reward for acceptance of the 
new faith and an incentive for the non believer (Mburu, 1981). Furthermore, Vola 
has always charged fees, a factor which limited access.
Health Services and Military Messianism 51 
Vola continues to be a major parallel source of Western biomedicine in Nigeria. 
However, its Christian origins tend to have restricted activities to the predominantly 
Christian southern half and the non Muslim nationalities in the north (Ityavyar, 
1988). 
Private medical enterprise (PME) 
PME dates back to the slavery period when, by an act of the British parliament 
(1789), it became obligatory "for all ships carrying slaves to have on board a 
licenced surgeon" (Schram, 1971). Indeed, it could be argued that Western 
medicine in Nigeria, as along the West African coast in general, owes its origins 
more to PME than any other source. 
After the abolition of slavery, PME existed mostly in the emerging corporations 
as well as in the few proprietory hospitals, clinics and maternity homes, mostly in 
urban centres. 
Unlike Vola, which was encouraged and even subsidised by the state, PME has 
been generally suppressedboth by Nigeria'scolonial and post colonial governments. 
According to Pearce (1980), the former used its political and economic power to 
undercut PME in several ways. It drastically reduced the charges in public 
hospitals, obviously to render PME unprofitable. In addition, only sick certificates 
from public facilities were accepted for purposes of sick leave and related sickrole 
benefits. 
Many reasons have been adduced for this persecution, primary among which 
are exploitation and quackery. 'Doctors' in private practice were, for instance, 
accused of exploiting the popularity of injections for material gain. This menace 
of 'injection doctoring' (the indicriminate administration of injections for a fee) 
was compounded by the problem of quackery. As part of the latter, "unqualified 
laymen with stethoscopes, lancets and syringes... even nurses, technical assistants, 
chemists and radiographers would join the pretence of being medically qualified" 
(Schram, 1971:347). 
In post colonial Nigeria, government's antagonism to PME has persisted until 
recently. As we have detailed elsewhere, through a military decree the government 
stipulated a mandatory five year post graduation experience as a prerequisite for 
entering private practice. The allegations of exploitation through rickety facilities, 
high fees, quackery and injection doctoring have continued (Alubo, 1990b; 
Amachuee, 1987). 
The economic crisis and the resultant austerity programmes seem to have 
turned the tide in favour of PME. To ease unemployment problems, including 
medical unemployment, the mandatory five year post graduation prerequisite has 
been abolished. Further, through the newly created National Directorate of 
Employment (NDE), the government now encourages self employment, including
52 5 OgohAlubo 
medical self employment, through loans and enterpreneurship courses. Finally, 
PME has become a particularly significant source of Western biomedicine, more 
so now that the public sector is in a major crisis. 
The public sector 
The public medical sector, now run by the Ministry of Health and its parastatal, the 
Health Services Manangement Board, originated as part of the efforts of European 
explorers and later, the colonial government, to contain infectious diseases. 
Initially, available care was restricted to the Europeans. Services were extended to 
the natives only as a means of reinforcing the cordon sanitaire between the former 
and the latter (Schram, 1971). 
This publicly funded system was inherited at independence, after which the 
care of government employees, and other members of the elite who took over from 
the colonialists, continue to take precedence over medical care for the generality 
of the people (Ityavyar, 1988; Stock, 1985a). Irrespective of its inequalities, the 
public system has the widest spread and largest clientele. 
Health and medical care in Nigeria are characterised by heavy investment in 
urban based biomedicine, access to which is limited to about 35 percent of the 
Nigerian population, estimated at 100 million. The majority of Nigerians who 
have no access to 'formal' western biomedicine utilise the services of traditional 
and folk healers as well as itinerant drug vendors, injection doctors and 'quacks' 
(Alubo, 1985b; Stock, 1985b). As a recent government policy document 
acknowledged (Federal Government, 1986a:4) : 
"The health services as currently organised show major defects which are 
widely recognised. The coverage is inadequate. It is estimated that no more 
than 35 percent of the population has access to modern health services. 
Rural communities and the urban poor are not well served. The orientation 
of the services is inappropriate with a disproportionately high investment 
on curative services to the detriment of preventive services." 
These investments incurativemedicineare.however.contradictedby morbidity 
and mortality experiences which point to nutrional, communicable and parastic 
(mostly water borne) diseases. The true nature and etiology of the major health 
problems are summed up thus (Federal Government of Nigeria, 1975:262): 
"Twelve preventable and communicable diseases have been identified as 
currently accounting for 95 percent of ill health and death in the country. 
The most prevalent ones are malaria, tetanus, measles, tuberculosis and 
meningitis." 
These hospitals and other centres for curative therapy are almost completely 
dependent on imported equipment (down to syringes and needles) and drugs, as 
well as substantial reliance on expatriate personnel, mostly physicians (Alubo,
Health Services and Military Messianism 53 
1985 a/b; Stock, 1985b). This dependency burden requires continued availability of 
foreign exchange. It was therefore hardly surprisingly that declining foreign 
reserves during the last years of the Second Republic translated into shortages of 
drugs and equipment, particularly in public hospitals. 
These shortages were unprecedented and generated enormous public outcry. A 
study during the period indicated that 70 per cent of prescriptions were out of stock 
and unavailable (Alubo, 1983). To be sure, the shortages, rather than the obvious 
disjuncture between heal thproblemsandinvestments, were regarded as constituting 
the crisis of health care. That the military would point to these crippling shortages 
as justification for intervention is therefore understandable. 
The military has addressed this crisis situation through various reforms which 
are broadly classified here as 1) rationalisation and commercialisation, 2) periodic 
crisis management, 3) cultivation privileges, and 4) the newpolicy of implementing 
health for all. 
Rationalisation and commercialisation 
Under this rubric erstwhile/ree and/or subsidised services are either withdrawn or 
user fees are levied. Thus, free meals for patients on admission have been 
discontinued, while charges for various services (eg consultation, bed, laboratory, 
surgery) have been reintroduced. These levies are periodically revised to reflect 
changing market prices. 
Besides these general levies, a scheme called the Drug Revolving Fund (DRF) 
has been instituted. As part of this scheme, itself part of the World Bank 
prescription in health care financing in underdeveloped countries, a large sum of 
money (capital) is made available to pharmacy units in public hospitals to purchase 
drugs. The drugs are sold to patients and the proceeds ploughed back into further 
purchases of drugs. The DRF scheme, essentially, involves running public 
pharmacies as businesses. 
On the surface, DRF appears to be an ingenious strategy for addressing the 
shortages in hospitals. There are, however, problems. The scheme does not 
address the dependency burden which relates to Nigeria's underdevelopment. In 
this way, revenue generated does not necessarily guarantee a greater availability 
of drugs. This latter must compete with other commodities for foreign exchange 
allocation. Secondly, perhaps more seriously, this commercialisation has meant 
outright exclusion for those without the economic ability to pay. Hence treatment, 
both for out and in patients, now require payment before service. Indeed, there 
have been cases of denial of treatment, sometimes with fatal consequences3. 
Thirdly, the new charges for drugs are superimposed on transportation and other 
problems, most of which relate to the contradictions between urban based facilities 
in a country where over 70% of the population is rural.
54 S OgohMvbo 
Periodic crisis management 
Periodic crisis management, essentially 'fire fighting', is perhaps best illustrated 
by the events that led to the nationwide doctors' strike in 1984. The doctors 
observed that public hospitals had deteriorated from "consulting clinics" to 
veritable "mortuaries where the sick are helplessly passing aways into irretrievable 
eternity" (Alubo, 1986:473). The doctors who seemed particularly concerned 
about the implications of the shortages for medical education in the clinical years 
engaged in strikes to demand improvement 
As part of the agreement to end the strikes a special task force was set up to 
expedite drug importation. This body had (Alubo, 1986:474): "extra ordinary 
powers to ensure the procurement of drugs and materials within one month, at the 
latest. This special task force was able to bring in the first consignment of drugs 
and materials within a fortnight". 
In like manner, after the 1989 riots in protest against the economic austerity 
programme special grants were made availble for drugs. As part of this package, 
drug manufacturers and pharmacy shops were promised easy access to foreign 
exchange for direct drug importation. 
These periodic panic measures are implicit admissions by government that the 
crisis situation has not abated. With reference to drugs, prices have more than 
quadrupled following the currency devaluation. Further, the acute shortages of 
drugs have persisted, the same is true of equipment. Indeed, as the Chief of General 
Staff, Nigeria's military Vice President, recently admitted, the country lacks the 
essential infrastructure for medical care delivery (quoted in African Concord, 
1989 Sept 25:20). 
True, the drug shortage is now compounded by the growing problem of fake 
drugs, a situation which has now necessitated the promulgation of the Counterfeit 
and Fake Drugs Decree. This decree is in addition to a special task force 
empowered to confiscate fake drugs as well as prosecute the widespread illegal 
sales of prescription drags. 
Like the DRF programme, these periodicpanic measure have madeanegligible 
impact on the shortages in public hospitals and on the overall health care crisis. 
Hospitalised patients arerequiredtohavearelation on hand to furnish prescriptions 
and other supplies. Indeed, the leadership of the military messiahs seems aware of 
the unabating crisis, hence it seeks medical treatment abroad, mostly in Europe. 
Cultivation of privileges 
While the majority of Nigerians must cope with shortages and other frustrations of 
the National Health Service, the same is not true of the top echelons of the military 
and their civilian counterparts who receive medical care overseas.
Health Services and Military Messianism 55 
It is difficult to provide accurate data on this unique privilege, particularly for 
those in the private sector who foot their own bills. However secret, overseas 
medical treatment of public officials and their families frequently leak. In some 
cases, there are official announcements. 
Since the 1983 coup a number of key government personnel have gone abroad 
for treatment According to newspaper reports, the wife of General Buhari was in 
West Germany for treatment when he was ousted in August 1985. In a similar case 
of this unique privilege, Mr Akabosu, Bendel State Police Commissioner (now 
retired) was flown abroad for medical care following injuries sustained from armed 
robbers. 
In early 1987 it was the turn of President Babangida himself, who was treated 
for some foot disease (radiculopathy) at the American Hospital, Paris. While 
hospitalised in France for a full month an official delegation led by General 
DomkatBalli (now retired) paid himavisit. The President's 'medical pilgrimage', 
as medical care abroad has come to be known, generated intense controversy, 
particularly as his condition could have been treated at home for a fraction of the 
cost, and because the Babangida government continues to emphasise sacrifice and 
selfreliance. 
Critics who pointed out the obvious contradictions between iherhetoric and the 
practice of selfreliance and sacrifice were, however, labelled 'mischievous'. This 
editorial passage in the Federal Government owned New Nigerian (March 7 
1987:11) is a good example of the official position: 
"Local mischiefmakers would have wanted us to entrust the life of our 
number one citizen to the inept hands of doctors (in Nigeria) who routinely 
forget surgical fittings in the stomachs of helpless patients." 
Since the president's trip several ministers in his cabinet have folllowed in his 
footsteps. These overseas trips are in addition to special provisions at home, where 
senior staff facilities are segregated from those of the ordinary Nigerian in whose 
behest the military supposedly intervened (Ityavyar, 1988). 
While the cultivation of medical privileges is not unique to military regimes, 
for a head of State to leave his post for a full month abroad appears legendary. As 
documented by Ityavyar (1988), Stock (1985b), Alubo (1987), and others, overseas 
treatment is a manifestation of inequality, including medical inequality. Yet it 
must be noted that continued medical care abroad by the same people who 
professed a commitment to resolving the crisis in public hospitals is an implicit 
admission that the medical care crisis has not been resolved. 
The 'New' policy of 'Health for All' 
In addition to the reforms already discussed, the military has launched a health 
policy titled "The Policy andStrategy to Achieve Healthfor all Nigerians" (Federal
56 S OgokAlubo 
Government of Nigeria, 1986), in pursuit of the Alma Ata Declaration of Health for 
All by the Year 2000 (HFA 2000). This policy is the second attempt to implement 
the HFA 2000 programme. The first attempt, the Basic Health Services Scheme 
(BHSS), was inaugurated during the 1975-80 Development Plan. But, as a 
government evaluation panel found, most BHSS projects were not completed. The 
implementation was "haphazard and ineffective" (National Institute for Policy and 
Strategic Studies, 1988). 
Like its abandoned predecessor, the new policy adopts the primary health care 
strategy and involves: 
* the division of the country into six zones on the basis of geographical 
location 
* involvementoflocalgovernmentsandthecommunityindata collectionon 
health problems as well as in workshops on how to resolve them 
* the involvement of villages in the selction of its members to be trained as 
Village Health Workers (VHW), and as Community Health Extension 
Workers (CHEW) 
* the phased implementation of PHC beginning with 52 local governments 
in 1986,80 in 1987,100 by 1988 and the entire country (over 560 local 
governments) by the year 2000. 
As part of this initiative, there is an intensified immunisation drive, the 
expanded programme on immunisation (EPI), and Oral Rehydration Therapy 
(ORT). The ultimate objective is to integrate primary, secondary and tertiary care 
such that the emergent system would be (Federal Government of Nigeria, 1986a:9) 
"promotive, protective, preventive, restorative and rehabilitative to every citizen". 
The implementation of HFA 2000 is, however, confronted by several problems. 
In the first place the new initiative has the payment of user fees as a general 
principle. As earlier observed, there are no provisions for the poor, whose ranks 
are daily swollen by the structural adjustment programme. By the same token, 
'health' care would exclude those without the ability to pay. Secondly, the 
implementation relies heavily on foreign supplies of vehicles, vaccines, and 
equipment down to refrigerators. The material basis of this heavy dependency 
burden is, however, being eroded by the economic crisis. The needed foreign 
exchange to sustain the. importation of these items is jeopardised by the collapse 
of cash crops (cocoa, groundnuts) and oil prices (the increase in prices triggered by 
the Iraqi invasion of Kuwait in the fall of 1990 made little difference), and the 
overall economic crisis. Finally, the implementation has concentrated on medical 
care, mostly vaccines and solutions, while it is clear that nutritional and parasitic 
diseases cannot be resolved by medication*. 
The contradictions between the enunciated objective of HFA 2000 and military 
messianism in general seem clear. These contradictions derive from the broad 
dynamics of the political economy.
Health Services and Military Mcssianism 57 
The political economy of health under the military 
This paper has illustrated that the populist rhetoric of the military has not been 
translated into policies beneficial to the generality of the Nigerian people. These 
contradictions between populist slogans and the reality of Nigeria's iniquitous 
system, including the health care system, relates to the political economy of public 
policy. 
Nigeria's political economy, as is now amply documented (see, for example, 
Bangura, 1987; Onimode, 1983; Usman, 1986; Othman, 1984) 11,61-65), and is 
characterised by subsistence agriculture and the overbearing presence of 
multinational corporations (MNCs) in the key sectors of the economy - oil, 
banking, and construction. This foreign domination permeates every aspect of 
Nigerian society, particularly the polity. In essence, therefore, decisions about 
whether and what the people eat, the availability of social services, including 
medical care, and human rights are all inextricably linked to this foreign dominated 
economy, and the internal interests which sustain it. In this way public policies 
invariably reflect and are constrained by this structure. Hence, it has been 
suggested, the primary objective of the Nigerian post colonial state is the 
protection of capital with the people as sacrificial lambs (Ohiorhenuan, 1989; 
Beckman, 1985). 
These foreign interests are realised through an intricate web of controls over 
machinery, spare parts, and expertise spun to further dependence on the metropole, 
and, more recently, through the IMF and the World Bank. 
Thus, without radical breaks with the status quo reforms will not significantly 
change the situation. The ongoing economic reforms, which foster dependence 
rather than selfreliance, are illustrative. Indeed as Charney (1987:60) has shown, 
through the ambit of debt scheduling and renegotiation: 
"The International Monetary Fund, clubs of private finance capital and now 
the World Bank have increasingly used the renegotiation of Africa's debts 
to negate their economic sovereignity, dictating economic policies and 
investment orientations." 
Coups, he continued, make little difference as: 
"The reigning faction changes, but there is no change in the form of state or 
the position of the foreign bourgeoisei. The world marketand foreign firms 
remain the ultimate sovereigns, and the state continues to diffuse commodity 
relations within its borders. The situation resembles a game of musical 
chairs." 
It is against this scenario that the role of the military in Nigeria polity can be 
fully understood. Military rule has not entailed any structural transformation. 
Indeed, it makes no pretentions to 'revolutionary' change. At best, it has 
consolidated existing structures and made reforms. In this way, the reality of
58 S OgohMubo 
military messianism pits itself against the professed advocacy of the 'common 
man', whose suffering continues to be determined by his class position. 
Yet, the military government has foreclosed any discussion of, let alone 
changes in, the ideology which informs the political economy and breeds poverty, 
unemployment and consulting clinics. Indeed, the government denies that 
economic policies and programmes in Nigeria are ideologically based. The 
impression is thus created that IMF conditionality and the World Bank structural 
adjustment programme, which constitute the fulcrum of recent economic policies 
in Nigeria, are non ideological. According to the present military government, 
Nigeria has no ideology nor would it impose one on the country. However, when 
the overwhelming majority (in a nationwide study conducted by the government 
appointed Political Bureau) chose socialism, this choice was rejected by the 
Babangida government. The capitalist origins of IMF and World Bank therapies 
are no longer in dispute5. 
Clearly, when shed of its populist garb, the military is essentialy an instrument 
of the dominant rather than the underclasses. Moreover, specific coups have been 
traced to intra class conflicts between various factions of the former (Turner and 
Badru, 1985). Thisclasscharacterofthemilitaryasaninstitutionalsoexplainsthe 
serial negation of its earlier proclamations. Indeed, military dictatorship is more 
consistent with existing structures of foreign domination as it circumvents and 
reduces the long process of legislation to military decrees. In Nigeria's case, such 
decrees cannot be challenged in the law courts. This is not, however, to suggest 
acquiesence. Military messianism has led to various forms of resistance and 
opposition. 
Military messianism and resistance 
The obvious contradictions between the rhetoric and reality of military messianism 
has led to opposition championed mostly by students and organised labour, 
including doctors and other health workers. 
In challenging the crippling shortages in hospitals, the National Association of 
Resident Doctors (NARD) argued that hospitals have further deteriorated from 
'consulting clinics' to transit camps to the mortuary in spite of the emergency 
importation of drugs (Alubo, 1986). Consequently, the doctors planned further 
protest strikes to force the government to stem the deterioration. For them, these 
strikes, much like military intervention, are patriotic acts (President of the Nigerian 
Medical Association, in Newswatch, 1985, February 25:19): 
"The same spirit of patriotism, nationalism and commitment to the cause of 
the fatherland that made it impossible for the military to sit back and fold 
its arms while the politicians ran the nation to a standstill makes it difficult
Health Services and Military Messianism 59 
for us of the medical profession to sit back and fold our arms while the 
medical services of the country remain in shambles." 
The government's reaction to 'medical patriotism' was swift and resolute. It 
denounced the doctors as (New Nigerian, 1985, February 23): 
"unpatriotic, selfish and callous professionals who have no regard for the 
serious economic predicament facing this country and the much needed 
peace requiredby the Federal Military Government to revamp the economy. 
The Federal Military Government has therefore decided that: 
1. The Nigerian Medical Association (NMA) and the National Association 
of Resident Doctors (NARD) are hereby proscribed with immediate effect. 
2. All doctors who are on strike, or have withdrawn their services in any 
way, are ordered to resume normal work at 7,30 am tomorrow... Failing to 
do this, they should regard themselves as dismissed from the service with 
immediate effect." 
In addition, private hospitals were prohibited from employing any doctors 
withoutpriorgovernmentapproval.Further,their travel documents were impounded 
to ensure they did not emigrate. 
These acrimonious confrontations between professional and state power have 
not eased the crisis. True, the availability of drugs and equipment are now more 
precarious due to foreign exchange difficulties. The crisis, as well as the general 
economic situation, have led to a major medical brian drain, mostly to Saudi Arabia 
and other Gulf States. In other words, one cannot even talk of 'consulting clinics' 
as many of the consultants have emigrated. 
Indeed, even in terms of budgeting allocation and expenditure, there has been 
a general decrease since the 1983 coup, although the overall pattern has been quite 
variable, as Tables 1 and 2 indicate. 
Both as a consequence of the brain drain and the continuing crisis many 
departments in the medical schools in Nigeria are now paralysed. The continuing 
deterioration in medical education led to the withdrawal of the accreditation of 
three (out of 13) medical schools in Nigeria While this withdrawal was, no doubt, 
to ensure quality, it has long term implications for the supply of medical doctors, 
more so, that shortages persisted when all 13 hiedical schools were at full capacity. 
Opposition to other aspects of the austerity programme is similarly suppressed. 
Thus, the leadership of the Nigerian Labour Congress (NLC), the umbrella labour 
organisation, was disbanded in 1988 for endangering "industrial peace and 
national security" (Newswatch, 1988, March 8:4),while the Academic Staff Union 
of Universities (ASUU) was outlawed in 1988 for "confrontation". Similarly, 
some workers of the National Electric Power Authority (NEPA) received life 
sentences for engaging in strikes in protest against the austerity programmes. As 
part of the growing repression, security forces had orders to shoot protestors on
60 5 OgohAlubo 
sight duringpopular revolts against the economic situation and austerity programmes 
in May 1989. 
Besides this overt state violence and supression, the government has instituted 
special tribunals, mostly headed by generals, which try economic and political 
offenses. The verdicts of these tribunals cannot be contested in conventional 
courts. 
Like the other problems, the high handedness, which the Babangida regime 
supposedly intervened to correct, has beenperpertuatedby his regime. Further, the 
Structural Adjustment Programme (SAP), as IMF conditionally and World Bank 
austerity programmes are called in Nigeria, is being pursued with military resolve 
in spite of the "harsh intolerable sufferings" associated with it. A recent study of 
the social impact of SAP found that it breeds (NISER, 1988:3): 
"mass poverty, declining standards of living, deepening inequality between 
social strata, rising unemployment, retrenchment, school drop-out, social 
disorganisation, hopelessness..." 
and, succinctly (:9): 
"suffering and pain heard from every quarter, at school, in the market, on the 
farm, in offices, at home." 
In this way SAP has aggravated exisiting problems. With reference to 
nutritional diseases, for example, Nigeria has experienced an astronomical increase, 
including those hitherto unknown to most physicians in the country, or last 
experienced during the civil war (Alubo, forthcoming). 
Nor has military messianism resolved the economic crisis which has been 
aggravated by the austerity programmes. Accroding to the World Bank (1989), the 
Gross National Product in Nigeria fell by over 25 percent between 1987 and 1989, 
an indication of the geneneral decline. Moreover, rather than attract foreign 
investment, as was anticipated, the crisis has led to divestment. Frustrated by the 
decreased purchasing power and collapsing social infrastructure, foreign investors 
are now moving to Eastern Europe and elsewhere. Major banks and corporations 
are leading this divestment process. 
It therefore seems clear that whether in terms of resolving the consulting clinic 
status of hospitals or the overall 'economic predicament', the reality of military 
messianism is belied by its rhetoric. This hiatus relates to the class character of 
military intervention which, as has been seen, stems more from intra class feuds 
than contradictions between the dominant and under classes. 
Conclusion 
This paper has discussed the rhetoric and reality of military messianism in Nigeria 
with particular reference to health services. Rather than deliverance from "harsh 
and intolerable conditions", military rule has, aggravated these conditions.
Health Services and Military Messianism 61 
Nigeria is by no means a unique case as her experience is shared by and large 
by most of Africa and Latin America6. The military have promised to bring about 
economic and political salvation (Amuwo, 1989). However, as in Nigeria "those 
who greeted the advent of the soldiers into politics as a new modernising force that 
is disciplined and capable of promoting progress, were terribly disappointed" 
(Cervenka, 1990:132). 
With specific reference to health, the situation in most of Africa is similar. As 
in Nigeria, the health care system is mostly curative, urban centred, dependent and 
caters mostly to an elite clientele. 
The Nigerian situation, however, differs in some respects. Whereas Nigeria is 
richer in terms of Gross National Product and per capita income than many African 
and Latin American countries (World Bank, 1989) it does not have any form of 
social security, subsidised food or otherprogramme targeted at the most vulnerable 
segments of the population - unlike poor countries like Ghana or Zambia (Any inam, 
1989; Kalumba, 1990). Many Latin American countries such as Brazil, Argentina 
and Chile also have some form of social security. 
As Szenftel has pointed out, militarism is characterised by the tendency 
(1989:4): 
"to increase internal repression; to respond to the demands of external 
interests while imposing further austerity on their citizenry (though not on 
themselves); and to increase internal disorder and turmoil... 
Whatever their [messianic] motives, they have inevitably imposed an 
authoritarian ruleandcultureon their societies and have invariably defended 
property against people. At worst they have made life arbitrary, dangerous 
and violent for their citizens." 
The deterioration in both the economic and human rights situation suggest that 
true solutions to Third World political economic problems, including health 
problems, must go beyond reforms to structural transformation. The former leads 
to temporary euphoria, as in Nigeria and Ghana, and the latter to lasting resolution 
of the social needs of the majority, as in Cuba. Unfortunately, military messianism 
is essentially antithetical to, rather than a vanguard of, such transformation. As an 
epithet on military messianism, "Beyond your redeemer" would be most 
inappropriate. 
FOOTNOTES: 
1. Thisisdonelhroughseveralpaidadvertisemcnl5eiititled"TheGainsofSAP". The primary health 
care programme is cited as one of these gains. See, for example, African Concord (1989) 
September 4, and President Babangida's speech on the subject in the New Nigerian, (1989) 
August 28. 
2. This coup attempt, on April 22, is documented in the popularpress. See, for example, Akinrinade 
S "Coup that crumbled" in Newswatch, May 7,199ft Since the attempt, the human rights situation 
has deteriorated with sweeping arrests and the closure of three independent papers. Further, 68 
people have been executed, after secret trials, for involvement in the coup.
62 S Ogoh Alubo 
3. Witness, for example, the denial of treatment to a women in Otukpo General Hospital because she 
could not afford drugs worth N12.50 (now under US$2). The woman later died. This incident 
received wide publicity because her death occured during the military governor's visit See the 
New Nigerian, (1988) Feb 4, and Stock (1985). 
4. The inherent contradictions of the HFA 2000 programme are discussed in Navarro V (1984) "A 
Critique of the Ideological and Political Position of the Brandt Report and the Alma Ata 
Declaration" in International Journal rf Health Services, 14,159-172; Zaidi A (1988) "Poverty 
and Disease: Need for Structural Change" in Social Science and Medicine, 27, 2, 119-127; 
Benerji D (1990) "Hidden Menace in the Universal Child Immunisation Programme" in 
International Journal of Health Services, 20,3,501-510. 
5. This position is clearly articulated by the Permanent People's Tribunal verdict, Tribunal on the 
Policies of the International Monetary Fund and the World Bank, West Berlin, September 26-29, 
1988, in International Journal of Health Services 0990) 20,2,329-347. 
6. The limits of military messianism is mostly clearly illustrated by the experience of Ghana where 
Jerry Rawlings first took over in June 1979. After the brief democratic period of Halila Lima, 
Rawlings returned in December 1981. This latter coup was, at least in the perception of the 
'disciples', analogous to the second coming of Jesus. Hence, Rawlings is nicknamed Junior Jesus, 
an obvious reference to the biblical Jesus, the Redeemer. Under his rule, the military promised 
to carry out revolutionary and anti-imperialist changes. As it turned out, the 'revolutionalry' 
regime of Rawlings, which initially bandied anti-imperialist rhetoric, is now up held by the IMF 
and the World Bank as the 'success story' of austerity programmes. See Anyinam C (1989) "The 
Social Cost of the International Monetary Fund's Adjustment Programmes: The Case of Ghana" 
in International Journal of Health Services, 19,3,531-547. 
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Table 1 
Federal Government Expenditure on Health 1980-1989 (N million) 
Year 
1980 
1981 
1982 
1983 
1984 
1985 
1986 
1987 
1988 
1989 
Source: Central Bank of Nigeria, in the Nigerian Economist (1989) 2-16,27. 
Table 2 
Sectoral Distribution of Federal Government Annual Budgets: 1983-1989 
Recurrent expenditure Nm 
Capital expenditure Nm 
Total expenditure Nm 
Allocation of total exp. % 
Production 
Agriculture 
Mining 
Manufacturing 
Economic services 
Commerce & finance 
Power 
Transp't & c'ation 
Social services 
Education 
Health 
Social development 
Environment services 
Water & sewerage 
13,0 
9,0 
Housing 3,8 
Environm'tal planning 0,2 
19,1 Defence & security 
General administration 
Transfers [to the states]1 
Source: Ukwu IU (1989) "Rural Development Policy and Programmes in Nigeria: A 
Critical Review", mimeo. 
1 The substantial increase in transfers to the states is probably due to the creation of two 
M,3 
additional states in 1987. 
Health Services and Military Messianism 65 
Amount 
190,98 
250,90 
90,75 
254,50 
131,20 
199,40 
320,40 
236,40 
443,20 
452,60 
1983 1984 1985 1986 1987 1988 1989 
4 708 6 072 5 473 5 636 10 775 13 709 20810 
5 283 2 052 5 803 5 946 6 742 10 658 9297 
9 991 8 124 11 276 11 582 16 887 24 367 30107 
9,7 
3,0 
4,7 
2,0 
8,6 
2,7 
6,0 
5,1 
0,4 
0,5 
9,7 
3,5 
9,6 
5,6 
1,5 
2,5 
17,6 
1,3 
1,2 
4, 
93
7 
0,2 
6,0 
16,0 
10,1 
2,3 
3,6 
1,2 
15,1 
13,0 
8,8 
3,1 
1,1 
4,9 
1,9 
2,5 
3,5 
1.2 
1,9 
7,4 
4,5 
2,8 
0,1 
17,5 
5,7 
0,4 
9,6 
8,0 13,2 
47,8 36,7 
% of total 
1,58 
2,24 
1,15 
2,21 
1,32 
1,65 
2,77 
1,35 
1,82 
1,50 
3,8 
1,6 
0, 
U
9 
3,7 
1,4 
1,2 
1,1 
3,2 
0,2 
6,5 
1,8 
3,3 
1,4 
8,6 
4,7 
16,4 
6,8 
7,3 
2,3 
10,3 
3,6 
5,3 
2,2 
0,5 
2,8 
5,9 
3,9 
1,4 
0,6 
0,2 
2,8 
9,2 
\7,0 
1,5 
0,7 
0,3 
3,6 
7,1 
4,6 
1,9 
0,7 
1,2 
5,5 
D,8 
9,5 
3,1 
1,2 
3,8 
0,9 
2,2 
0,7 
9,8 
11,7 
4,5 
1,2 
3,2 
0,1 
14,6 
8,9 
3,0 
0,8 
1,9 
0,3 
6,9 
11,3 
2,5 
0,6 
1,9 
0,2 
8,5 
11,5 
62,5 62,7 52,7 31,4