Reviews SOUNDINGS

Ghosts

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7527.1279-a (Published 24 November 2005) Cite this as: BMJ 2005;331:1279
  1. Imre Loefler, editor
  1. Nairobi Hospital Proceedings, Kenya

    The decay of Africa's health care has taken place in stages, each stage corresponding to the development theory that was fashionable at the time.

    The first theory saw development in purely economic terms and proposed that African countries—where medicine was district hospital and health centre based—should follow the path that Europe and America had taken. The result was the construction of sophisticated teaching hospitals and the introduction of Western style specialisation.

    When it was recommended that industrialisation should drive development, the rate of urbanisation increased, slums appeared, and tertiary hospitals were overwhelmed and could not accept referrals.

    In the 1960s sociologists joined the development teams and “cultural heritage” had to be respected. The bare foot doctor, the herbalist, and the traditional birth attendant had their day, and the warm word “community” gained currency.

    Health centres and district hospitals were still built, but as the teaching hospitals and the just established postgraduate training were Western oriented the graduates could no longer cope with the disease patterns typical of a district hospital.

    The development backlash came in the 1970s, from among the African intelligentsia, who discovered “neocolonialism” and a “false paradigm” in every move of the West and of the international agencies. The “dependency theory” became the bogeyman. The medical profession was ostracised for “Western leanings.”

    In the wake of Mrs Thatcher and President Reagan the last remnants of free medical care were disassembled and the medical profession was encouraged to engage itself in the commercial sector.

    In the 1990s the prevalent developmental theory spoke of “district focus” and “endogenous growth,” but these words had no effect on the now dilapidated and deserted district hospitals. By this time the teaching “centres” were also decaying and, as the teachers were busying themselves in the private hospitals, the students and the postgraduates were left with the internet preaching Western “gold standards.”

    Already one wonders whether the millennium goals and the spirit of Gleneagles are just another set of ghosts.

    View Abstract