Disease control and public health have been key aspects of social and political life in sub-Saharan Africa since time immemorial. With variations across space and time, many societies viewed disease as the result of imbalances in persons and societies and combined the use of materia medica from the natural world, spiritual divination, and community healing to redress these imbalances. While early encounters between African and European healing systems were still marked by mutual exchanges and adaptations, the emergence of European germ theory-based biomedicine and the establishment of racialized colonial states in the 19th century increasingly challenged the value of African therapeutic practices for disease control on the continent. Initially, colonial states focused on preserving the health of European soldiers, administrators, and settlers, who were deemed particularly vulnerable to tropical climate and its diseases. Around 1900, however, they started paying more attention to diseases among Africans, whose health and population growth were now deemed crucial for economic development and the legitimacy of colonial rule. Fueled by new insights and techniques provided by tropical medicine, antisleeping sickness campaigns would be among the first major interventions. After World War I, colonial health services expanded their campaigns against epidemic diseases, but also engaged with broader public health approaches that addressed reproductive problems and the social determinants of both disease and health. Colonial states were not the only providers of biomedical healthcare in colonial Africa. Missionary societies and private companies had their own health services, with particular logics, methods, and focuses. And after 1945, international organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) increasingly invested in health campaigns in Africa as well. Moreover, Africans actively participated in colonial disease control, most notably as nurses, midwives, and doctors. Nevertheless, Western biomedicine never gained hegemony in colonial Africa. Many Africans tried to avoid or minimize participation in certain campaigns or continued to utilize the services of local healers and diviners, often in combination with particular biomedical approaches. To what extent colonial disease control impacted on disease incidence and demography is still controversially debated.
Apollos Okwuchi Nwauwa
With the arrival of Europeans in West Africa in the 15th century, which preceded formal conquest and pacification, missionaries took the lead in introducing Western education as an indispensable tool for effective evangelism. Subsequently, the various European colonial governments appropriated education as a means of consolidating colonial rule in West Africa. By the middle of the 19th century, Western education began to produce a new, educated elite, at the core of which were “liberated slaves” in Sierra Leone. Western education produced its own contradictions. On the one hand, it produced educated hybrids who were alienated from their own peoples and cultures and who collaborated with Europeans to entrench colonialism in West Africa. On the other hand, the new elite, educated both in Africa and overseas, subsequently morphed into the new nationalists who became valuable agents for the liquidation of European imperialism in Africa. The emergent institutions of higher learning and the three new universities in West African founded in the aftermath of World War II became hotbeds of intellectual discourse just as the debate over the need for adaptation and Africanization resurfaced. Following the end of colonial rule, the “new elite,” now expanding in number, continued to provide contentious, neocolonial leadership and direction for development in postcolonial West Africa. Thus, despite its undesirable effect on European colonialism, Western education played into the hands of the educated elite who appropriated and deployed its latent, potent force in order to dislodge Europeans from Africa.