No. XV of 1930-31. Gold Coast. 
CORRESPONDENCE 
RELATING TO 
A Scheme for Extending the 
. System of Village Dispensaries 
and Improving the Training 
of the African Nursing and 
Dispensing Staff. 
Ordered by His Excellency the A cti-ng Governor to be Printed. 
GOLD COAST: 
Pyinted by the Goveynment Printer at the Government Rrinting Office, Accra. 
To be purchased from the Gove rnment Pl'intil1g Office (PI~blicatiolls Branch), 
Accra, Gold Co~,st Colony, a1!d from the Crown Agents fOl' the Colonies, 
4 , Millbank , London, S. W . I. 
1930. 
Price-One Shilling . 
No. XV of 1930-31. . Gold Coast. 
CORRESPONDENCE 
RELATING TO 
A Scheme for Extending the 
System of Village Dispensaries 
and Improving the Training 
of t~e African Nursing and 
Dispensing 'Staff. 
Ordered by His Excellency the Acting Governor to be Printed. 
GOLD COAST: 
Printed by the Government Printer at the Government Printing Office, Accra. 
TOi be purchased from the Government Printing Office (Publications Branch), 
Accr.a. G'old Coast Colony, ' and from the Crown Agents for the Colonies, 
4, Mil/bank, London, S. W. I . 
1930. 
I. 
Despatch from the Govemor to the Secretary of State. 
GOVERNMENT HOUSE, 
ACCRA, 
2nd June, I930. 
My LORD, 
I have the honour to refer to that part of the Report of the Committee, 
appointed by the Secretary of State in 1927, which dealt with a scheme 
for the creation and training of an auxiliary service of Medical Assistants, 
and to paragraph 16 of Sir Ransford Slater's despatch of the I7th 
"November, 1928, in which he informed Mr. Amery that he approved that 
scheme in principle and would submit his views after questions of details 
and costs had been settled. 
2. The scheme first submitted by the Director of Medical and 
Sanitary Services (Dr. Inness) in 1928 followed closely the recommen-
dations of the committee and was a costly one. The estimated capital 
expenditure on school buildings aLone, spread over three years, was 
£73,000. It ,*vas proposed to build the school for Medical Assistants at 
Korle Bu on such lines that it could be used eventually as a college for 
training Medical Practitioners, the idea being that if and when the 
I college scheme was proceeded with, the school buildings could be taken 
over by the col,lege and a new school for Medical Assistants built at 
Kumasi. Accommodation was provided for 90 students, 30 being taken 
in each of the first three years. The course was to be one of four years, 
and the total number of Medical Assistants aimed at was 2 SO. Recurrent 
costs, with the full complement of students, were estimated at £6 ,000 per 
annum, and it was calculated that the bill for salaries, when the full 
number of 250 Medical Assistants had been trained, would amount to 
;,)6,500 per annum. To this had to be added £18,750 for the cost of 
necessary emp1,oyees, transport, travelling atld incidental charges, 
excluding drugs and dressings . . 
3. These proposals were submitted to the Executive Council, and 
the Council advised that they were too costly. Conflicting views as to 
policy were also expressed with the result that the Governor asked Dr. 
Inness for his considered opinion as to whether such additional money as 
Government might be able to afford for medical needs in the next twenty 
years could most profitably be spent on 
1. training, say, 120 Medical Assistants, or 
u. increasing the number of Medical Officers and permanent hospitals, 
or 
1ll. increasi.ng the number of Medical Officers with travelling dispen-
sanes. 
4. Dr. Inness unhesitatingly advised the adoption of course (i), and 
was requesteato prepare a less costly scheme for consideration. At the 
same time, his attention was called to the Sierra Leone scheme which was 
submitted to the Secretay of State in Mr. Young's despatch No. 327 of 
4 
the 23rd June, 1929, a copy of which was supplied by the Governor of 
Sierra Leone for the information of this Government. 
5. In November last, Dr. [mless submitted a simplified scheme. 
The course suggested was still to be one of four years and the curriculum 
similar to, but sl,ightly less full than, that proposed by the I927 committee. 
Accommodation was provided for a maximum of 40 pupils, and ten pupils 
would enter the school each year until 80 Assistants (the maximum 
number proposed) had passed out. At the end of the fourth year the first 
ten pupils would pass out and be posted as Medical Assistants to dispen-
saries in various centres. Thus, in the fifth year there would be 40 pupils 
and ten Medical Assistants, and in the tenth year 40 pupils and 60 Assist-
ants. Thereafter the number of pupils would decrease to a figure sufficient 
to maintain an establishment of 80 Medical Assistants. 
The capital cost of the modified scheme was estimated as follows :-
£ 
School lecture rooms (at Korle Bu) 6, ISO 
Initial equipment 1,000 
80 dispensaries and Medical Assistants' quarters 
(spread over eight years commencing from 
the fourth year) 57,000 
In order to avoid the cost of non-essential buildings, no provision 
was made for hostels for the pupils, and it was proposed that they should 
live out and be paid at the rate of £48 per annum during their training. On 
passing out, it was proposed to pay the Medical Assistants the following 
salaries :-
Medical Assistants £154- 10-£208 
Senior Medical, Assistants £222-12-£282 
Chief Medical Assistants £300-20-£400 
The teaching staff required was one Medical Tutor and two Science 
Masters. 
Recurrent costs were estimated to rise from £2,590 in the first year 
to £29,700 in the twelfth and subsequent years. 
6. The modified scheme, while less costly in every respect than the 
original proposals, was received at the time the Estimates for the current 
year were under consideration. A careful analysis of the financial 
position was made, and the Governor reLuctantly carne to the conclusion 
that it would not be prudent to provide funds for the scheme in those 
Estimates. 
At the same time Sir Ransford Slater remained of the firm opi~:on 
that an extension of the dispensary system was badly needed. In (he 
Gold Coast there are practically no dispensaries, except those attached 
to the 32 hospitals widely scattered through the Colony, Ashanti and 
the Northern Territories. Facilities for treatment are admittedly 111-
adequate, and I append a minute in this connection by Mr. W. J. A. 
J ones (Secretary for Native Affairs):-
" The fact that there are only 32 hospitals in th.~ Gol,d Coast 
and its dependencies, with a total area of 91,600 square miles, or in 
other words one hospital to approximately every 2,860 square mil.es, 
affords ample evidence of the necessity for providing more extensIve 
facilities for medical treatment, and I am convinced that every 
Political Officer with up-country experience will agree that this need 
can best be met by the establishment of dispensaries in the larger 
towns where there are no hospitals at present. 
• 
5 
" Owing to the expense which travelling and absence from their 
homes entail Africans who live in towns or villages situated some 
distance from district headquarters do not as .1 ruie consult the Medic;~1 
Officers until native or patent medicines have failed to cure them of 
their particular diseases. The result frequentLy is that a patient is 
brough.t to a doctor only when there remains but little hope of his 
recovery. He dies in hospital, the faith of the inhabitants of his 
village in the superiority of the white man's medicine over their own 
is badly shaken, and aU suggestions from the Political Officers that 
other sufferers from illness should go into the district hospital for 
treatment are received with suspicion". This is a true account of the 
experience of all Political Officers who have interested themselves 
in the bodily well-being of the people urder their care. What 1 
desire to emphasize is that if it can be avoided, we should not restrict 
the activities of the Medical Department and consequently the benefit 
of medical science to district headquarters and to the educated section 
of a district's population. To exemplify this argument let us take 
the case of the Keta district. There are several villages of con-
siderable size both along the banks of the Vol ta and beyond the 
lagoon where Medical Officers are only known to the average inhabi-
tant as unpleasant persons who appear on the scene, generally 
supported by the District Commissioner and Police, whenever there 
is an -outbreak of smallpox. To people such as these the value of 
proper and early treatment will remain unappreciated until we are 
able to introduce some such system as that advocated by Dr. Inness. 
The Awoame Fia has frequently, both in Legislative Council and 
in letters to Government, stressed the necessity for providing dispen-
saries at Dsodje and elsewhere in his State. He certainly contem-
plates, and with every reason, that, if his request is granted, the 
dispensaries will be visited at frequent and regular intervals by a 
Medical Officer, but I am convinced that the principal object which 
he has in view, as has every other Chief who makes a similar request, 
is to provide his people with some institution not too distant from 
their homes where they may obtain medicine for common ailments, 
dressings for their sores, and so on. 
" The dispensary buildings form the largest item of capital 
expenditure in the Director of Medical and Sanitary Services' 
scheme, and here I am sure we may count on the assistance of the 
Chiefs, most of whom would be prepared to pay either the whole or 
a considerable portion of the cost of a unit, i.e., dispensary and 
dispensers' quarters, which is calculated at £712 lOS. od. if built in 
concrete. In the poorer States the building would probably be made 
of swish and the cost reduced in this way as well as by the use of 
communal labour. 
'1 J 
" I am in entire agreement with His Excellency that the provision 
of dispensaries, 'iupervised and visited periodically by the Medical 
Officers, would prove a real boon to the people of the Gold Coast, 
and I strongly recommend that the Director of Medical and Sanitary 
Services' scheme for the training of Medical Assistants be adopted 
or, if the present financial situation renders this impossible, that 
additional dispensers be trained to take charge of the dispensaries 
which I confidently anticipate the native authorities themselves will 
provide if asked to do so by Government." 
Unquestionable, the addition of 80 dispensaries, served by trained 
assistants, who can render first aid and dispense medicines for the common 
forms of ailments, would be a real boon to the people of the Gold Coast. 
The Governor, therefore, felt that every effort should be made to provide 
these dispensaries and the necessary staff. . He instanced the fact that 
wherever he went on trek, he was asked by chiefs for the establish men t 
• 
6 
of dispensari s in their towns; and gave directions for the written opinion 
of Executive Council to be o\)taincu as to what ste.:ps could usefully be 
taken, in view of the chan ged financial position of the.: Colony, to deal 
with the problem. 
7. I have obtained the views of Members of the Executive Council. 
The Colonial Secretary (Mr. Jackson), after reviewing the problem 
of how best to bring medical treatment within the reach of as large a 
number of the population as the present financial resources of Government 
permit, advises that the dispeJ1Sary scheme proposed by Dr. Inness should 
be proceeded with gradually, but he is of opinion (\i;lt there is no necessity 
to create and train 'a new grade of Medical Assistant. He considers that 
steps shou ld be take n to amplify the training given to dispensers so as 
to qualify them to take charge of village dispensaries, under the super-
vision of visiting Medical ORicers, deal with ordinary dressings, ulcers and 
sores, render first-aid generally, and dispense stock medicines and other 
common remedies [or prevalent and well recognised ai lments. 
The Attorney-General (IVlr. Abrahams), the Treasurer (Mr. Kelly), 
the Secretary for Native Affairs (Mr. Jones) agree with the views of the 
Colonial Secretary. rile Director of l\Iedical and Sanitary Services (Dr. 
Inness) also agrees that, for the reasons enumerated by Mr. Jackson, the 
scheme should be confined in the first instance to the amplification of the 
training of dispensers so as to. fit them to take charge of village 
dispensaries. 
8. The matter was discussed by Sir Ransford Slater with the Colonial 
Secretary and the Director of Medical and Sanitary Services in the first 
week of April; and the Governor directed that steps should be taken to 
initiate the system of training on the lines proposed by Mr. Jackson and 
agreed to by Dr. Inness. The latter, who has now submitted definite 
proposals to that effect, wri tes :-
" Our present system turns out (\·\ '0 separate classes of worker; 
on the one hand nurses, \\ ho are quite untrained in dispensing, and 
on the other dispensers, \\ho arc only partially trained in nursing. 
1 have no doubt whatever, and m)' opinion on the subject is fully 
shared by all the senior members of tbe staff, that a system of training 
which would, if it \\ere possible, combine that of a nurse with that 
of a dispenser would produce a type of man much better suited to 
local conditions and bound to be of greater assistance to a Medical 
Officer in his station, and to the general public. 
" The system I wish to introduce already exists in Sierra Leone 
and works there quite well. I would point out that it produces there 
the sort of man suitable for our projected scheme of Village Dis-
pensaries, as well as one who can do the ordinary dispensing of a 
110 pital or clinic. A Medical Tutor is included in the proposed 
scheme and he will be in a position to add an elementary training 
in midwifery, sanitation, etc., thus further enhancing the value of the 
final product of villagc dispensing \\ork." 
9. The intention is to train tbe dispenser to become a first-aid 
administrant, an acti\·c health propagandist, and a general assistant to the 
Medical Officer, under whom he works. The training will be carried out 
in the Gold Coast Hospital and in the Dispensing S~bool in Accra, but, 
to obtain the fullest benefit, it is essential that a su itable lecture room 
should be provided. All students will join the service as Nurses-in-
training, the title of Dispenser-in -training (,It'{' item [6 of the Estimates) 
being abolished. They will sp nd alternate months in the hospital wards 
and in the Dispensing School. At the cnd of three ycars, they will be 
eligible to sit for the exam ination for nurses when, if successful, they 
will be appointed Second Divisiol1 N llrses on probation. They will the~ 
7 
continue their training in the wards and the dispensing school until th ey 
pass the Examination for Druggists. When this has been passed, they 
will be eligible for appointment as dispensers in charge of village dis-
pensaries, or be required to serve in a Government hospital if the 
requirements of the service so demand. The course of training will last 
from three and a half to four years. The grades of Chief Nurse and First 
Division Nurse will be abolished in the case of men, and in their case 
posts above the grade of Second Division Nurses will be classified ::is 
Dispensers, First Division Dispensers and Chief Dispensers. The train-
ing of female nurses will contil:1Ue as at present, and the grades of First 
Division Nurse and Chief Nurse will be retained for them. 
IO. Dr. Inness has been able to effect appreciable reductions in both 
capital cost and recurrent expenditure as compared with the costs of 
his modified scheme (see paragraph 5 supra). 
The cost of the dispensaries and quarters for the dispensers remains 
at the same figure (£57,000) but expenditure on these buildings will be 
spread over a period of eight years, commencing from the fourth year 
from the introduction of the scheme. I would observe, however, that 
there is every reason to anticipate that the Native Authorities will them-
selves provide many of the required dispensaries and quarters (s ee Mr. 
Jones's minute quoted in paragraph 6 supra) so that the commitments of 
Government in regard to those buildings is not expected to be heavy. The 
only other capital expenditure will be £850, which is the estimated cost 
of a modest building to serve as a lecture room for 40 pupils. 
The following increases of establishment are involved: -
(a) Eighty additional dispensers to staff the required number of 
village dispensaries. 
(b) A Medical Tutor. 
The increase of 80 dispensers will be effected gradually, and the only 
immediate increase contemplated is ten nurses-in-training to be added 
to the strength from the inception of the scheme. 
N urses-in-training will be paid at the rate of £48 per annum, and the 
salaries for qualified dispensers will remain the same as at present, viz . :-
Dispensers £54-6-84; £r IO-8-158; £174-IO-224 . (See 
paragraph IO of, and enclosure 2 to, 
Governor's despatch No. 144 of the 19th 
February, 1930). 
First Division Diso-
pensers £222-12-282. 
Chief Dispensers £300-12-396 . 
A field allowance of £36 per annum will be paid to dispensers when 
attached to village dispensaries. 
The Medical Tutor is required to organise and supervise the course 
of training, and to lecture in elementary chemistry, physiology' , anatomy 
and pharmacy. Dr. Inness recommends the appointment of a Medical 
Practitioner to the post with salary as for Medical Officers, West African 
Medi.cal Staff, and with Staff Pay of £150 per annum in lieu of private 
practice. 
Including the salaries of the Medical Tutor and the additional dis-
pensers, the recurrent cost of the scheme will rise from £1,696 in the 
first yea,r to £5,774 in the fifth year, £r8,374 in the tenth year, and 
£24,372 in the fifteenth year, by which time it is anticipated that 80 full y 
qualified dispensers will be available for the village dispensaries. 
8 
11. It is propo cd to t()mmel1C~ th new !lcheme of trnining in July 
with Ihirl\·- thr'" tud nls, namely the ten additional nur es-in.training 
ref rred to in pnragraph 10 abo e, and twenty-three students who will be 
appointed to fill vacancies in the xisting estahlishment of nurses and 
dispel1!:lers. 
12. The schcm' repres 'nts an earnest effort to extend the benefits 
of medical treatmcnt to as many of the inhabitants of the Gold Coast as 
the present financial situation permits. It involves a small initial 
expenditure and does not commit Government to any large increase of 
recurrent cxpenditur cven when it is fully ·developed. I trust, therefore, 
that Your Lordship will sec fit to approve thc proposals outlined in 
paragraphs <)-1 T of this dcspatch. In that event, T shall be glad if early 
teps may be taken for the appointment of a Medical Tutor. As soon 
as Your Lordship's approval is received, the construction of the lecture 
r00111 will be begun, and the engagement of tbe ten additional nurses-in-
training wi 11 be proceeded wi th. 
13. A copy of this despatch is being sent to Sir Ransford Slater, 
who expressed his agreement generally with the scheme before his 
departure. 
q In conclusion, I desire to place on record the ability with which 
Dr. Inness has prepared the various schemes which have been considered, 
and the readiness 'which he has shown to amend those schemes to meet the 
changed financial circumstances of this Government. Those amendments 
have, I know, entailed much work on his part. 
I have, etc., 
G. C. DU BOULAY, 
Acting Govemor. 
THE RIGHT HONOURABLE 
LORD PASSFIELD, P.C., 
ETC., ETC., ETC. 
II. 
Despatch from the Secretary of State to the Govemor. 
No. 635. DOWNING STREET, 
JIst July, I9Jo. 
SIR, 
I. have the honour to acknowledge the receipt of your despatch No. 389 
of the 2nd of June, and to convey to you my approval of the proposals 
outlined in paragraphs 9 to I I for extending the system of \'illage dis-
pensaries and improving the training of the native nursing and dispensing' 
staff. 
. 2. I agree that, having regard to the financial position of the Colony, 
it would not have been prudent to proceed with the scheme for the creation 
and training of an auxiliary service of native Medical Assistants; but I 
consider that the present proposals are sound and practicable, and I 
endorse your remarks concerning the care and industry which Dr. Inness 
has applied to the consideration and preparation of the various propo als 
whic', have been under examination. 
9 
3. As regards the appointment of a Medical Tutor, I shollid 11 <.: g lad 
if you would consider in the first instance, whether there is any officer on 
the existing establishment of the Medical Department whom you could 
recommend for the post. This would seem preferable to the appointment 
of a candidate from outside, as it would ensure that the officer would be 
one who has had some experience of local conditions. 
4. If, however, there is no officer on the existing staff whom you 
would wish to recommend for the post, I shall endeavour to find a suitably 
qualified candidate, and I propose to inform the selected officer that he 
will be a member of the West African Medical Staff, assigned to this 
post; but that, if he finds the work of training the African subordinate 
staff uncongenial, or if the responsible Medical Authorities so decide, 
he will then be liable for service as a Medical Officer as may be thought 
desirable. 
I have , etc., 
PASSFIELD. 
THE OFFICER ADMINISTERING THE 
GOVERNMENT OF THE GOLD COAST. 
Ill. 
D espatch from tile Govemor to the Secretary of State. 
GOVERNMENT HOUSE, 
No. 634. ACCRA, 
I6tlz September, 19jo. 
l\fy LORD, 
I have the honour to acknowledge the receipt of Your Lordship's 
despatch No. 635, dated the 3 1st July, I930, approving the proposals 
for extending the system of village dispensaries and improving the training 
of the African nursing and dispensing staff in the Gold Coast. 
2. The Acting Director of Medical and Sanitary Services , a copy 
of whose memorandum is attached, reports that there is no officer suitable 
for the appointment of Medical Tutor on the existing establishment of the 
Medical Department. I shall therefore be glad if steps can be taken to 
select as ~oon as possible a suitably qualified candidate for the post, as 
proposed 111 paragTaph 4 of the despatch under acknowledgment. 
I have, etc., 
G. C . DU BOULAY, 
Acting Governor. 
THE RIGHT HONOURABLE 
\ LORD PASSFIELD, P.C., 
ETC., ETC., ETC. 
10 
Enclosure to No. 111. 
MEDICAL DEPARTMENT, 
P.O. Box 138, 
VICTORIABORG, ACCRA, 
2nd September, 1930. 
RESPECTING APPOINTMENT OF MEDICAL TUTOR IN 
CONNECTION WITH EXTENSION OF VILLAGE 
DISPENSARIES AND THE IMPROVEMENT OF 
THE TRAINING OF THE NATIVE NURSING 
AND DISPENSING STAFF. 
SIR, 
I beg to acknowledge the receipt of your letter of the nnd August, 
1930, attaching a letter from the Secretary of Stat.:= dated 31st July, 1930, 
and have to inform you that there is no officer in the existing establish-
ment of the Medical Department on the Gold Coast that I can recommend 
for the post of Medical Tutor. Two Medical Officers that I considered 
might have successfully filled the appointment have declined the offer-
one while { greatly appreciating the offer frlt that he had no aptitude for 
an appointment of this nature'; the other regretted the work would not 
be congenial to him. 
2. Under the circumstances I request that the Secretary of State be 
asked to select a suitable candidate under the terms proposed in paragraph 
4 of his letter. 
G. HUNGERFORD, 
A cting Director, Medical and Sanitary Service. 
THE HONOURABLE 
THE COLONIAL SECRETARY, 
VrCTORIABORG, ACCRA.