Governing Health Systems In Africa

Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expanded needs. Government responsibilities and objectives in the health sector have been redefined, with private sector entities (both for profit and not-for profit) playing an increasingly visible role in health care provisions. The reasons for collaborative patterns vary, but chronic under-funding of publicly financed health services is often an important factor. Processes of decentralisation and health sector reforms have had mixed effects on health care system performance; while private health insurance markets and private clinics are pointers to a growing stratification of the health market, in line with the intensified income and social differentiation that has occurred over the last two decades.These developments call for health sector reforms.

Governing Health Systems: For Nations and Communities Around the World examines the complex relationships between governance and performance in community and national health systems. Each chapter provides an in-depth case study, using both qualitative and quantitative methods, on health systems in many countries, including Uganda, Ghana, India, Zambia, Japan, Nigeria, Indonesia, Brazil, Palestine, and South Korea. The chapters were written by former Takemi Fellows, who were mid-career research fellows at the Harvard T.H. Chan School of Public Health, and their colleagues. This case study approach yields important findings as well as contextual insights about the challenges and accomplishments in addressing governance issues in national and community health systems around the world. Health policymakers around the world are struggling to address the multiple challenges of governing health systems. These challenges also represent important themes for the research mission of the Takemi Program in International Health at the Harvard T.H. Chan School of Public Health. This book is based on the program’s thirtieth anniversary symposium held in October 2013 at Harvard. The studies presented in this book—deep examinations of illustrative examples of health system governance for communities and nations—contribute to our knowledge about global health and assist policymakers in dealing with the complex practical problems of health systems. In short, this book addresses central questions about governing health systems—and why governance matters.

This volume addresses the ideational and policy-oriented challenges of Africa’s health governance due to voluntary and involuntary cross-border migration of people and diseases in a growing 'mobile Africa'. The collected set of specialized contributions in this volume examines how national and regional policy innovation can address the competing conception of sovereignty in dealing with Africa’s emerging healthcare problems in a fast-paced, interconnect world.

Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expanded needs. Government responsibilities and objectives in the health sector have been redefined, with private sector entities (both for profit and not-for profit) playing an increasingly visible role in health care provisions. The reasons for collaborative patterns vary, but chronic under-funding of publicly financed health services is often an important factor. Processes of decentralisation and health sector reforms have had mixed effects on health care system performance; while private health insurance markets and private clinics are pointers to a growing stratification of the health market, in line with the intensified income and social differentiation that has occurred over the last two decades.These developments call for health sector reforms.

A timely inquiry into how domestic politics and global health governance interact in Africa. Global health campaigns, development aid programs, and disaster relief groups have been criticized for falling into colonialist patterns, running roughshod over the local structure and authority of the countries in which they work. Far from powerless, however, African states play complex roles in health policy design and implementation. In Africa and Global Health Governance, Amy S. Patterson focuses on AIDS, the 2014–2015 Ebola outbreak, and noncommunicable diseases to demonstrate why and how African states accept, challenge, or remain ambivalent toward global health policies, structures, and norms. Employing in-depth analysis of media reports and global health data, Patterson also relies on interviews and focus-group discussions to give voice to the various agents operating within African health care systems, including donor representatives, state officials, NGOs, community-based groups, health activists, and patients. Showing the variety within broader patterns, this clearly written book demonstrates that Africa's role in global health governance is dynamic and not without agency. Patterson shows how, for example, African leaders engage with international groups, attempting to maintain their own leadership while securing the aid their people need. Her findings will benefit health and development practitioners, scholars, and students of global health governance and African politics.

Today’s era of intense globalization has unleashed dynamic movements of people, pathogens, and pests that overwhelm the static territorial jurisdictions on which the governance provided by sovereign states and their formal intergovernmental institutions is based. This world of movement calls for new ideas and institutions to govern people’s health, above all in Africa, where the movements and health challenges are the most acute. This book insightfully explores these challenges in ways that put the perspectives of Africans themselves at centre stage. It begins with the long central and still compelling African health challenge of combating the pandemic of HIV/AIDS. It then examines the global governance responses by the major multilateral organizations of the World Bank and the World Trade Organization and the newer informal flexible democratically oriented ones of the Group of Eight. It also addresses the compounding health challenge created by climate change to assess both its intensifying impact on Africa and how all international institutions have largely failed to link climate and health in their governance response. It concludes with several recommendations about the innovative ideas and institutions that offer a way to closing the great global governance gaps and thus improving Africans’ health and that of citizens beyond.

This book focuses on Africa’s challenges, achievements, and failures over the past several centuries using an interdisciplinary approach that combines theory and fact and evidence-based practices and interventions in public health, and argues that most of the health problems in Africa are not a result of scarce or lack of resources, but of the misconceived and misplaced priorities that have left the continent behind every other on the globe in terms of health, education, and equitable distribution of opportunities and access to (quality) health as agreed by the United Nations member states at Alma-Ata in 1978.

The globalisation of research has resulted in the increased location of research involving humans in developing countries. Countries in Africa, along with China and India, have seen research grow significantly. With emerging infectious diseases, such as Ebola and Zika, emphasising the risk of public health crises throughout the world, a further increase in health research, including clinical research in developing countries, which are often the sites of these diseases, becomes inevitable. This growth raises questions about domestic regulation and the governance of health research. This book presents a comprehensive and systemic view of the regulation of research involving humans in African countries. It employs case studies from four countries in which research activities continue to rise, and which have taken steps to regulate health research activity: South Africa, Nigeria, Kenya, and Egypt. The book examines the historical and political contexts of these governance efforts. It describes the research context, some of the research taking place, and the current challenges. It also looks at the governance mechanisms, ranging from domestic ethical guidelines to legal frameworks, the strengthening of existing regulatory agencies to the role of professional regulatory bodies. The book analyses the adequacy of current governance arrangements within African countries, and puts forward recommendations to improve the emerging governance systems for health research in African and other developing countries. It book will be a valuable resource for academics, researchers, practitioners and policy-makers working in the areas of health research, biomedical ethics, health law and regulation in developing countries.