Social History of Medicine Advance Access published online on June 2, 2009
Social History of Medicine, doi:10.1093/shm/hkp007
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Hospital Policy in Sub-Saharan Africa and Post-Colonial Development Impasse
* Institute for International Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK. E-mail: BmcPake{at}qmu.ac.uk
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Abstract |
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The pattern of hospital development was set in colonised sub-Saharan countries in the early twentieth century on the basis of the demands of the colonial project and the strategies of missions. In the immediate post-independence period, democratic and egalitarian policy in some countries pointed to the expansion of health services to under-served areas. However, the idealism associated with independence waned and more pronounced tensions emerged. Plans for expanded primary health care systems were sacrificed in favour of hospital services for a privileged elite. Over the same period, a group of international agencies have been associated with the promotion of more egalitarian and primary health care-focused strategies. But there has been a failure to engage at the political level and a willingness to accept instead token assent to the strategy. The consequence for hospitals has been an impasse. Hospitals do not meet elite expectations but neither do resources reach the larger population.
Keywords: Sub-Saharan Africa; hospitals; political economy; health systems; international development assistance