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estimate. There are now 13 university institutions that will share this number of students. There may, in fact, be a "disguised surplus" of students. That is, students are available but are not qualifying for faculty admission. The federal government has proposed that the universities devise course systems, eg, basic science schools or an extra year of study, which will enable more students to be admitted. This is, of course, against a background of expanded secondary school programs. The government is setting up a committee through the National Universities Commission to look into problems of university admissions. The medical schools base their clinical instruction largely in teaching hospitals. The relationship of the hospitals with the universities has varied. The University College Hospital, Ibadan, and the Lagos Univer-

MAY, 1976

sity teaching hospital have independent boards of governors that are answerable to the Federal Ministry of Health. The teaching hospitals in Zaria, Benin, Enugu, and Ife are run as part of the universities. There are certain problems in running the teaching hospitals independently of the medical schools and universities. The federal government has therefore set up a working party to study and determine the structure of the medical schools in relation to their universities and teaching hospitals. The structure that is envisaged is one in which the dean is at the head of faculty, with a director of studies (academic) and a director of hospital (hospital services) who are accountable to the dean. With ten medical schools of reasonable size, each graduating an average of 200 students annually, the pace would be set for the next phase of development.

Health and Nigeria's Third National Development Plan* EDWARD'B. ATTAH, M.D. Department ofPathology, University of Ibadan, Ibadan, Nigeria

Health care development figures prominently in Nigeria's third national development plan that was launched in April 1975. The previous two national development plans (1962-1968 and 1970-1974) also featured health care development, although with limited success. Money was scarce in Nigeria during the first plan, and execution of the health aspects of the second plan were hampered by administrative problems. The present health care system covers about 25% of the population and is aimed at hospital and curative care. Although the available statistics show that infectious diseases account for more than 50% of health problems, there are few of the much-needed preventive health services except in assisted programs of smallpox eradication and measles control. Concern for the nation's health has not been limited to government. In April 1966, the Nigerian Medical Association took the initiative and examined national health problems at its annual convention. The association set up a national planning committee to organize study groups to deliberate the issues and produce specific recommendations. At its March 1975 meeting the Association again considered problems in the provision of health care. NATIONAL PLANNING PROJECT

The tasks of defining government policy, setting targets, and making projections were undertaken by the National Health Planning Project, which was commissioned by the federal government with the assistance of the United Nations Development Program and World Health Organization. The project examined the guidelines for the third national plan and the initial recommendations of the ministries of health of all 12 Niger*Reprinted with permission from AMA, Oct. 6, 1975. Z. Danilevicius, Senior Editor.

ian states and the federal government to determine how well the submitted statements conformed to the guidelines and stated government policies and objectives. All the states were visited, and the policy fulfillment gaps in the health plans submitted were discussed. Factors affecting the achievement of health objectives were identified as follows: shortage of medical and paramedical staff, inadequate and maldistributed health facilities and institutions, inadequate preventive health facilities, poor health services management, and inadequate planning. As a result of the project, the major governmental policies formulated for the new development plan will include (1) training programs to increase the number of health personnel who are currently in short supply, (2) correction of imbalance in the location and distribution of health institutions, (3) measures to expand the control of preventable communicable diseases, and (4) standardization of the organization, administration, and management of health services. BASIC HEALTH UNITS

For the provision of health care, a basic health service program that envisions a network of coordinated basic health service structures staffed by competent health personnel has been proposed. This program is composed of basic health units (BHU), each of which will provide care for approximately 50,000 people. The BHU will consist of one comprehensive health center, four health centers (1/10,000 persons), five mobile clinics (1/10,000), and 20 health clinics (1/2,000). The staff of a BHU will consist of two physicians, two public health nurses, five nurses, eight midwives, eight community nurses, 25 community health nurses, one x-ray technician, two laboratory technicians, two health inspectors, two dental hygienists, and six medical records assistants.

Briefs

Vol. 68, No. 3

The health clinic, which is the first level of basic health service, will provide health care (including family planning), nutritional service, school health service, environmental health inspection and activities, and health education. Mobile clinics will provide a means of reaching rural areas with health personnel and services. The health center will supervise health clinics and also provide mass public health campaigns, public health nursing, outpatient clinics (including dental clinics), emergency treatment, inpatient facilities, portable x-ray, small operating room, laboratory, and health office. The comprehensive health center will supervise the satellite health centers and clinics. FUTURE NEEDS

There are presently six teaching hospitals in Nigeria. Under the new development plan, the federal government will build one teaching hospital in each of the 12

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states, at a cost of $297 million. This will increase the present number of available teaching hospital beds from 2,798 to 11,000 by 1980. In addition, 12 schools of nursing and midwifery will be built at a cost of $30 million, and 12 schools of health technology at a cost of $39.6 million. Two hundred eighty additional BHUs will be required by 1980 to achieve a 40%-population coverage, 460 for 50% population coverage, and 640 for a population coverage of 60%. At an estimated cost of $907,500 each, the BHUs for a 40% population coverage will cost approximately $254 million. Coverage of 50% of the population will cost $417.5 million and 60% coverage will cost $581 million. By 1980, the number of general hospitals will be increased from 339 to 400. The total number of available hospital beds will therefore be increased from 42,698 to 87,000, a reduction of the bed-patient ratio from 1/1,700 to 1/1,000.

The Kenneth W. Clement Center For Family Health Care

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A new building, the Kenneth W. Clement Center for Family Health Care, located at 2500 East 79th Street, Cleveland, Ohio, was dedicated to the memory of the late Dr. Kenneth W. Clement* on February 29, 1976. The Hon. Louis Stokes, member of Congress from Cleveland, was the guest speaker at the ceremony. The new center represents a joint effort of the Cuyahoga County Hospital system and the Cleveland Clinic Foundation. It is a medical treatment center to provide comprehensive primary health care for the entire family and is open to anyone who lives in Cuyahoga County and is in need of medical care. *v. this Journal, v. 67, pp. 252-255, 1975.

When in full operation the Center will have three medical teams, a dental team and a mental health team. Each medical team will be staffed with physicians, nurse practitioners and social workers. The medical staff will be full time. Costs will be based on the patient's ability to pay, consistent with current medical charges in the community. The center will cooperate with methods of payment such as Medicare, Medicaid and insurance. No one will be turned away because he cannot afford to pay. Dr. Henry Ziegler is medical director and Mr. Benjamin M. Priestley is community relations coordinator for the center.

Health and Nigeria's Third National Development Plan.

256 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION estimate. There are now 13 university institutions that will share this number of students. There ma...
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