History has set African health care up for failure. Lack of trained health workers places a massive burden on many African health care systems, inadequate or non-existent infrastructures make provision of basic needs like food and water impossible, debt and limited budgets move health care to a lower financial priority, medications are expensive and multinational pharmaceuticals want to make big profits, colonialism, apartheid, neo-colonialism, and the effects of an oppressed history perpetuate inadequacies in health care.

The varied record of health in Africa over the past century is inseparable from the history of change in control over political institutions and change in the organization of economic production. In the early years of colonial rule some governments relied on forced labor; in parts of colonial Africa, especially in the eastern and southern parts of the continent, male workers migrated from rural homes, leaving their families behind; in the postcolonial years class differentiation has become more pronounced, with some workers permanently separated from their roots in the countryside.[1]

Feierman and Janzen are right on target again in describing the scene of African health in relation to colonialism, politics, and history. African countries inherited health care systems from colonial authorities, but very often there was no health workforce to fill the void of colonial medical professionals. One Frenchman wrote,

La suele excuse de la colonisation c’est la medecin [the only excuse for colonialism is the doctor] – Hubert Lyantey (1926)[2]

If nothing else colonization was a positive in establishing health care systems and providing professional doctors? I wish I could agree, but mission societies that often ran health services relied on negative images of Africans.[3] The famed Dr. Livingstone was a doctor with the London Missionary Society and is best known for his explorations of the continent that allowed colonial empires to penetrate further into and conquer the African interior.

The slow demise of colonization did not end Western interference in Africa. Well into the 1980s and 1990s some African populations remained under the oppressive control of Western and minority populations. This control led directly to the ill health of those populations, notable South Africa and Mozambique. Black South Africans were denied basic health care services, training, and other needs.[4] South Africa fought a proxy war in Mozambique that specifically targeted the destruction of health care infrastructures. In African countries that gained earlier independence there were other powers to face.

[...] the IMF and World Bank have much to answer for. [Their] policies have eroded Africa’s health care systems and intensified the poverty of Africa’s people. – Salih  Booker[5]

Structural Adjustment Programs (SAPs) and other policies forced by Western institutions made the development from colonialism to independence that much more difficult for African countries. As Hunter writes, these policies often increased the poverty of African populations as opposed to providing for their basic needs. Health became a lower priority as African countries fell into debt because of loans from the IMF and SAPs of the World Bank. Even today with the economic recession African governments are cutting their health budgets to make ends meet. Health services should be the last item cut from a budget as health is central to all other human development.

Health is a major issue in Africa as the basic needs becoming increasingly difficult to provide and there have already been numerous reforms and attempted mechanisms to provide adequate health care.

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[1] Feierman and Janzen, 5.

[2] Hunter, 136.

[3] Ibid, 144.

[4] Hill, 6.

[5] Hunter, 47.

Tags: Africa, apartheid, colonialism, disease, Dr. Livingstone, health, health care, infrastructure, neo-colonialism, oppression