During Medieval times, the region that is now Ivory Coast was at the centre of several major African trade routes, linking the empires which then existed in Ghana and Mali. European traders had been present in the region since the 15th century, but it was not until the 19th that the French undertook a determined penetration of the region.
The public medical services of Ivory Coast are more important than the small number of private physicians and clinics. As of 2004, there were an estimated 9 physicians, 31 nurses, and 15 midwives per 100,000 people. About 77 percent of the population had access to safe water in 2000. Total health care expenditures were estimated at 3.7 percent of GDP.