Book launch: A celebration of the past and a vision for the future
- To recognise and celebrate African leadership in health,
- To describe in practical terms how African leaders have successfully improvised and innovated, building on the strengths of their communities and improving the health of their people; and
- To set out a vision for the future which shows how a new relationship can be created with international partners and demonstrates how insights and experiences from Africa can help improve health globally.
We hope, too, that this book will be an inspiration to Africans to claim the future for themselves.
Written by Africans for Africans
Most accounts of health and healthcare in Sub Saharan Africa are written by foreigners.[i] This book redresses the balance. It is written by Africans who have themselves led improvements in their own countries and describes many of the features of leadership, policy and implementation which have been involved. It is about Africans reclaiming their place as leaders in health.
Health leaders in Sub-Saharan African countries face some of the most demanding challenges anywhere in the world. Disease, poverty, the legacy of colonialism including the post-colonial power imbalance and, all too often, conflict and political instability, combine to make improving health and healthcare extraordinarily difficult. Nevertheless, in chapter after chapter, health leaders describe how they have made progress. There are many lessons here for the rest of the world.
The authors demonstrate how social and cultural issues can inhibit or accelerate improvement and, using their understanding of these issues, describe how they have mobilised communities and individuals with stunning results. As Professor Miriam Were of Kenya says in Chapter 8 “Through this approach, health-promoting and disease-preventing norms develop in the community” and “If it doesn’t happen in the community, it won’t happen in the nation”.
In leading change, the authors invariably have had to identify and make the best use of the assets they have to hand, developing new practices and bringing new people and resources into play. In Chapter 12, for example, Dr Pascoal Moccumbi describes how as Mozambique’s Minister of Health after the revolution of 1974 – when there was an exodus of Portuguese doctors – he faced such a shortage that he decided to train non-medical Tecnicos de Cirurgia to do emergency obstetric surgery. They continue to operate successfully today not only in Mozambique but in other African countries as well. This is an example of an African innovation that has now been formalised by the World Health Organisation (WHO) under the name of Task Shifting and is beginning to be applied in developed countries.[ii]
Author after author has also shown how health relates to everything else in their society – from education and the environment to the economy and future prosperity of the country. Health has to be part of all policies, integrated into the national poverty reduction and development plans. Others have had to argue, as Dr Aron Motsoaledi, the South African Minister of Health, describes in Chapter 18 that “You soon won’t have enough people to build the roads or other investments unless you tackle HIV/AIDS”. Health can’t be treated just as a separate department or enterprise. It affects and is affected by everything else.
A distinctive vision for Sub-Saharan African healthcare
Taken together, these and other approaches create what amounts to a distinctive vision for health in Sub-Saharan Africa where “Health is made at home” from the complex intermingling of behaviour, customs, science, education and economic factors. Good health starts with and is created by individuals, their families and communities and is supported, where necessary, by the skills, knowledge and technology of the professionals; not the other way round. Health is the domain of the people more than of the professionals. It is an approach which is reflected in and reinforced by the different ways in which major policies, such as universal health coverage, are being developed in different countries.
International organisations, development partners, foreign NGOs and private businesses play major roles in health and healthcare in most Sub-Saharan African countries with differing degrees of success. As these writers demonstrate, 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.
A new paradigm for partnership with the international community
More importantly, it is time to change the relationship between Sub-Saharan Africa and development partners and the wider world. As Francis Omaswa writes in Chapter 2, “Africans went to … institutions and countries begging for advice and for money and we got both but in exchange for certain core values.” Africans were the junior partner in all these partnerships and a sense of dependency was created. Now, however, the world has moved on.[iii] The future is about interdependence and co-development. Richer and poorer countries both need each other and can learn from each other.[iv]
Africa may be undergoing a renaissance but all is not rosy.[v] There are over-powerful elites, corruption, appalling inequalities between rich and poor and, all too often, between men and women, and some harmful traditional practices remain a challenge. Poverty persists and health problems are more complex and diverse than anywhere else on earth. Globalisation and growth are bringing many benefits in education, health and wealth; but these are accompanied by plagues of fast foods and obesity, new forms of foreign exploitation and economic exclusion.