ABSTRACT
Nearly every African country committed to making healthcare a social good at the time of independence. Furthermore, except for the 1980s, when African countries were subject to the ‘shock therapy’ of structural adjustment programs by the World Bank and International Monetary Fund, this commitment has been repeatedly reaffirmed. Yet, across much of Africa, healthcare policy produces systems that are ineffective, exclusive, and expensive for a majority of citizens. The main argument of this chapter is that politics and the economy in Africa, as they are currently embedded in the post-colonial state and primary commodity production, greatly hinder the implementation of the kind of effective, inclusive, and cost-efficient healthcare policy that Africa needs to face the health challenges of the Twenty-First Century. These challenges include rising morbidity from so-called ‘rich man’s diseases’ (e.g. cancer and heart disease), pandemics (e.g. Ebola and COVID-19), and endemic, so-called ‘poor man’s diseases’ that continue to plague the continent (e.g. malaria, childhood diarrhea, cholera, yellow fever). At the same time, even in the absence of fundamental change to African political economies, strong leadership and judicious allocation of scarce healthcare resources (e.g. in public health) can help to palliate some of the worse ills of African healthcare.
