The sheer size and diversity of Africa makes it difficult to present a balanced account on any issue on the continent. Yet Jean-Germain Gros managed to navigate the pitfalls of generalisations by presenting a compelling account of the evolution of healthcare policy in Africa. The book's central thesis is that ‘healthcare policy does not take place in a vacuum’ but it is ‘intimately connected to, and significantly influenced by, the institutional environment, which includes the socio-economic and political matrix – in sum, structure internal to Africa – as well as external factors such as colonialism …’ (p. 12).
Scholars in public healthcare policy will find the first chapter illuminating as it presents the various theoretical lenses for analysing healthcare policy in Africa. The only drawback, though, is that scholars who are not well-grounded in social theory (such as structuralism, Marxism, Foucault's various concepts such as governmentality and biopower) might find the material difficult to comprehend. In defence of the author, one might argue that theory is a powerful tool of analysis that provides useful insights that one would probably not get in its absence.
Jean-Germain Gros shows that Africans had developed their own responses to illnesses centuries before colonialism. This was disrupted by colonialism which, among other things, introduced a healthcare policy that catered mainly for the White population and largely neglected the African population. This gap in healthcare was bridged, to a limited extent, by European missionaries who established hospitals that provided free healthcare to the African population. Mission hospitals also played a key role in the spread of Christianity on the continent: ‘(h)ealing the body of Africans was the entry point to rescuing their souls from the ‘evils’ of African society’ (p. 57), and ‘was a way to help spread the word of God’ (p. 58). Whatever their motive, Christian missionaries should be credited for their role in availing modern healthcare to the African population that was largely neglected by the colonial government.
The author shows the role played by colonial past in shaping healthcare policy in post-colonial Africa. While African countries were committed to providing universal healthcare access, the adoption of structural adjustment programmes meant the introduction of cost-recovery fees, which disadvantaged the poor. Chapter 4 statistically measures the influence of local institutions on healthcare policy in Africa. Here the author makes some important associations, for example, between per capita GDP and health status. Other associations, however, might be open to different interpretations. For instance, he notes that ‘a percentage increase in (Internet) connectivity is predicted to decrease HIV/AIDS prevalence by 0·05 percent’ (p. 149). Obviously, there needs to be intentionality on the part of the government and other local/international institutions to spread the message on HIV/AIDS prevention methods and these are not limited only to the use of the Internet.
Chapter 5 profiles some of the humanitarian organisations that work on Africa's healthcare landscape. Here Foucault's concept of governmentality is invoked to show how ‘government(s), private actors, and humanitarians play their part in improving the African health condition’ (p. 183). Chapter 6 presents a case study of healthcare policy in Botswana, Ghana and Rwanda. Despite the financial pressure that they have faced, ‘African policy makers did not think that healthcare should be a private good, the purchase of which African consumers should be entirely responsible for’ (p. 241).
The book concludes by examining some of the challenges currently faced by Africa's healthcare systems. Perhaps reflecting the time when the book was written, the author examines the outbreak of the Ebola pandemic in West Africa in 2014. While the pandemic exposed the lack of proper healthcare planning policies in the affected region, readers might also question the role of international institutions such as the World Health Organization (WHO) in managing such crises. The book concludes by examining the role played by Cuba in strengthening Africa's healthcare system (a model of South-South cooperation) and ‘how countries of the South can significantly scale up their healthcare human power, even under conditions of serious budget constraints' (p. 252).
One major criticism of the book is that it focuses largely on sub-Saharan Africa and makes scant reference to North Africa, which is part of Africa after all. One would also have wanted to see an in-depth discussion of how African countries are dealing with the HIV/AIDS pandemic and how they have responded to the brain drain of health workers from the continent. Notwithstanding these criticisms, Jean-Germain Gros' book is a welcome addition to the literature on healthcare policy in Africa and probably presents the most compelling account of healthcare policy in Africa to date.
