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A History of Health Systems in Africa: Swiss Mission Hospitals and Rural Health Delivery in the 20th Century

How can historical research data contribute to a better understanding of health services? How can this knowledge contribute to the development of sustainable health systems in developing countries?

Project Summary

The main aim of the project was to contribute to a better understanding of health services in developing countries through Swiss Missions by using historical research methods. The research is based on two case studies located in Ghana (Agogo Hospital: Basel Mission) and South Africa (Elim Hospital, Mission Romande). The research team was especially interested in examining the interaction between health care providers and their changing political, social and economic environments.

They studied the activities of former Swiss missionary hospitals and the changing conditions under which they delivered various forms of health care. The ultimate aim is to show how history can contribute to the development of sustainable health systems. Historical explanations for the success and failure of health systems can serve to inform today’s decision-makers. The study applied the methodologies of history and social anthropology, as well as (historical) epidemiology in order to examine the effects of political, economic, social and cultural changes on disease and health environments.

Academic Output

Working Paper

History of Health Systems in Africa

This scientific report outlines the comparative history of rural hospitals which were built and developed by three Swiss missionary societies in Sub-Saharan Africa. The three case studies from South Africa, Ghana and Tanzania have produced self-standing results concerning the research aims defined by the ‘History of Health Systems in Africa’ project research frame. This throws light on the transnational history of Switzerland and on the meaningful role played by former Swiss missionary health institutions and their representatives in the devel- opment of rural health care systems in Sub-Saharan Africa. This study does not primarily aim at writing a history of three Swiss mission hospitals, but at producing an analysis of their very different actors and their practices as well as their various health policies and strategies over time and in different African contexts and environments. Several major findings were pro- duced and different nodal points have arisen; nevertheless, this report analyses and compares the most prominent ones which have mainly emerged in the still on-going research process: the (shifting) historical and political context of the development of Swiss mission hospitals (Section I); the (changing) characteristics and representations of these health institutions in Sub-Sahara Africa (Section II); their (moving) main actors and their (varying) impact on hos- pital-related rural health care (Section III).

Working Paper

This project subjects three Swiss mission hospitals in Ghana, South Africa and Tanzania to an examination using the tools of History and Anthropology. The hospitals provide us with a means of entering into both the transnational history of different Christian missions and their influence on, and encounter with, diverse health systems in the continent. This allows for a comparative approach that highlights differences and commonalities and that raises new questions. By choosing an inter-disciplinary approach the study challenges the meaning created by dichotomies such as Christian-heathen, universal-local, European-African, professional-amateur and modern-traditional. Our approach destabilizes the fixity of these labels and underlines the dynamics of change in institutions and practices related to health in Africa.

Our study underlines the importance of financial structures to the ways in which hospitals fulfil their role in society. As mission hospitals attempted to serve a wider rural public, they had to turn to the state and secular officials for help. This undermined their spiritual and evangelical nature and confirmed the importance of the state and donor agencies in their development. During this time the hospitals became important rural sites for medical training and ‘decolonisation’. Outside influences and local needs pushed them to become important laboratories in the construction of ‘hospitals without walls’. This study particularly recognises the vital contribution of these rural hospitals to wider health systems.

Research Team

Patrick Harries
Coordinator
University of Basel

Marcel Dreier
Principal Member

Hines Mabika
Principal Member
University of Basel

Brigit Obrist
Principal Member
University of Basel

Pascal Schmid
Principal Member
University of Basel

Peter Van Eeuwijk
Principal Member
University of Basel

Status

completed

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