Making And Unmaking Public Health In Africa

Africa has emerged as a prime arena of global health interventions that focus on particular diseases and health emergencies. These are framed increasingly in terms of international concerns about security, human rights, and humanitarian crisis. This presents a stark contrast to the 1960s and ‘70s, when many newly independent African governments pursued the vision of public health “for all,” of comprehensive health care services directed by the state with support from foreign donors. These initiatives often failed, undermined by international politics, structural adjustment, and neoliberal policies, and by African states themselves. Yet their traces remain in contemporary expectations of and yearnings for a more robust public health. This volume explores how medical professionals and patients, government officials, and ordinary citizens approach questions of public health as they navigate contemporary landscapes of NGOs and transnational projects, faltering state services, and expanding privatization. Its contributors analyze the relations between the public and the private providers of public health, from the state to new global biopolitical formations of political institutions, markets, human populations, and health. Tensions and ambiguities animate these complex relationships, suggesting that the question of what public health actually is in Africa cannot be taken for granted. Offering historical and ethnographic analyses, the volume develops an anthropology of public health in Africa. Contributors:Hannah Brown, P. Wenzel Geissler, Murray Last, Rebecca Marsland, Lotte Meinert, Benson A. Mulemi, Ruth J. Prince, Noémi Tousignant, and Susan Reynolds Whyte

Most accounts of health and healthcare in Africa are written by foreigners. African Health Leaders: Making Change and Claiming the Future redresses the balance. Written by Africans, who have themselves led improvements in their own countries, the book discusses the creativity, innovation and leadership that has been involved tackling everything from HIV/AIDs, to maternal, and child mortality and neglected tropical diseases. It celebrates their achievements and shows how, over three generations, African health leaders are creating a distinctively African vision of health and health systems. The book reveals how African Health Leaders are claiming the future - in Africa, but also by sharing their insights and knowledge globally and contributing fully to improving health throughout the world. It illustrates how African leadership can enable foreign agencies and individuals working in Africa to avoid all those misunderstandings and misinterpretations of culture and context which lead to wasted efforts and frustrated hopes. African Health Leaders challenges Africans to do more for themselves; build on success; tackle weak governance, corrupt systems and low expectations and claim the future. It sets out what Africa needs from the rest of the world in the spirit of global solidarity - not primarily in aid, but through investment, collaboration, partnership and co-development. It concludes with a vision for improvement based on three foundations: an understanding that 'health is made at home'; the determination to offer access to health services for everyone; and an insistence on the pursuit of quality.

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and – albeit sometimes counterintuitively - trust for their people. “The state” has morphed into the “para-state” — not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the “global health” paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional. Contributors. Uli Beisel, Didier Fassin, P. Wenzel Geissler, Rene Gerrets, Ann Kelly, Guillaume Lachenal, John Manton, Lotte Meinert, Vinh-Kim Nguyen, Branwyn Poleykett, Susan Reynolds Whyte

Countries in sub-Saharan Africa were once dismissed by Western experts as being too poor and chaotic to benefit from the antiretroviral drugs that transformed the AIDS epidemic in the United States and Europe. Today, however, the region is courted by some of the most prestigious research universities in the world as they search for "resource-poor" hospitals in which to base their international HIV research and global health programs. In Scrambling for Africa, Johanna Tayloe Crane reveals how, in the space of merely a decade, Africa went from being a continent largely excluded from advancements in HIV medicine to an area of central concern and knowledge production within the increasingly popular field of global health science. Drawing on research conducted in the U.S. and Uganda during the mid-2000s, Crane provides a fascinating ethnographic account of the transnational flow of knowledge, politics, and research money—as well as blood samples, viruses, and drugs. She takes readers to underfunded Ugandan HIV clinics as well as to laboratories and conference rooms in wealthy American cities like San Francisco and Seattle where American and Ugandan experts struggle to forge shared knowledge about the AIDS epidemic. The resulting uncomfortable mix of preventable suffering, humanitarian sentiment, and scientific ambition shows how global health research partnerships may paradoxically benefit from the very inequalities they aspire to redress. A work of outstanding interdisciplinary scholarship, Scrambling for Africa will be of interest to audiences in anthropology, science and technology studies, African studies, and the medical humanities.

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and "albeit sometimes counterintuitively - trust for their people. The state has morphed into the para-state " not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the global health paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional.

The first principle of public health practice is defined as the identification of the root cause or causes of all health problems, from the diseased individual to the effects on that individual of family, social, community, national, global, environment and other factors. The second principle is defined as the utilisation of the resources of the community, the nation and the world to effect a lasting and, often, a cheaper solution to health problems. This comprehensively revised and updated edition of the first volume provides a ready source for principles and practice, and more practical advice than the first edition which did not fully cover all the aspects of a comprehensive public health practice. The contributors are all practitioners, and the emphasis throughout is to bring out the principles involved in identifying the root causes of all types of health problems, and discovering practical and innovatory solutions for them in ways best suited to African countries.

The closure of the Millennium Development Goals (MDGs) in 2015 prompted the need for a book of this kind. An interdisciplinary group of global health scholars contribute to the understanding of the emerging and fast-growing problem of the dual burden of communicable and non-communicable diseases (NCDs) in Africa. This book is timely, as the international community has moved from the MDGs to adopt the Sustainable Development Goals (SDGs) as the blueprint for a new human development agenda. Contributions and case studies are situated in the revised Epidemiologic and Nutrition Transition Model to capture the current situation, referencing communicable and NCDs on the African continent. The case studies encapsulated aim to help minimize negative health outcomes and improve population health, well-being, and equity in the future. This book will be significant in policy circles to assist international organizations, governments, and United Nations agencies. It aims to chart the future for health in Africa in light of recently adopted SDGs. This book is also a useful complementary reader for global public health related courses.

The challenges to better health services in Africa are well known: Africa lags behind all regions of the world, including other developing regions, on all indicators of better health. A recent report from the World Health Organisation for instance shows that while Africa has 20% of the world's sick people, it has only 4% of its healthcare workers - many of them vulnerable to the high mortality rate associated with malaria and notably the AIDS epidemic. The state of investment in healthcare infrastructure is also grossly inadequate as is the efficiency of healthcare delivery. But does this need to be so? What factors are responsible for this unacceptable state of affairs? Contributors to the volume examine the evolution of healthcare services in Africa, the ongoing national, regional and continental efforts to improve the delivery of healthcare in the continent, and the direct and indirect obstacles militating against the maturation of the services and their efficient delivery. The contributors - all distinguished experts in the field, who hold either challenging responsibilities in health in Africa or have worked in multiple components of the healthcare delivery system in the continent - also provide powerful personal insights and lessons learned in their current or previous work in the health sector in Africa. Some of the themes covered include clinical care and centers of excellence, healthcare finance and resource mobilization, primary health care systems and community health; preventive care and risk reduction in health; the role of reference laboratories; clinical research and partnerships, the role of epidemiology, statistics, monitoring and evaluation in health services; the role of the African Diaspora, and the role of politics in the organization of healthcare and the training of medical and other health professionals. From their analyses and experience the authors articulate proven strategies and solutions based on consensus expert opinions on how to improve the quality of health services and health outcomes in the continent.