Partners in Health – Alex B. Hill

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Before you have anything else, you have your health. Hopefully if you have nothing else, at least you have your health. Unfortunately, for millions across the African continent this is not an absolute fact. Even more unfortunate is the fact that many Africans have no ability to change their health status. They are trapped in a system that is driven by Western market based, profit driven health care systems. As the failures of Western development practices come to light, alternatives to what has been are becoming increasingly visible. These alternatives will form a revolution in African health care delivery. This revolution will be fueled by health care delivery models that will give local communities agency in the provision of their own health care. Community-based models involving cooperative financing, proven para-professional training, new information technology, and social enterprise for the social good will drive the revolution in African health care. People will be able to determine for themselves, their level of health.

What does “Health” mean anyway?
This is a question often left to remain ambiguous. For the purposes of my writing I will provide a comprehensive view of “health” and all that is entailed in sustaining and maintaining health. “Health” in all instances will refer directly to the “basic needs” of a person in regards to health care.

Healing, like health, is obviously rooted in the social and cultural order. […] To define dangerous behavior, and to define evil, is to define some causes of illness. As the definition of evil changes, so does the interpretation of illness. To understand change in healing, we must understand what it is that leads people to alter the definition of dangerous social behavior. It can easily be accepted that health and healing in Africa are shaped by broad social forces.

As Feierman and Janzen state, health (and healing for that matter) are directly linked to social forces. If a comprehensive understanding of health is to be understood, it must be studied in the context of politics, economics, and other societal structures.

Health is defined by the World Health Organization (WHO) as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO and many other international organizations recognize that this broad and encompassing definition of health. Where this definition becomes ambiguous is what qualifiers meet, “a state of complete physical, mental, and social well-being.” In 1978 the WHO made primary health care its number one objective with the Declaration of Alma Ata. However, even this statement had no clear definition of health or its qualifiers.

Feierman and Janzen provide a more clear definition of the qualifiers of health in the preface to their volume: The Social Basis of Health and Healing in Africa,

[…] it [health] is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease. Such a view is necessary if we are to understand those contexts in today’s Africa where health levels deteriorate, and where they improve.

These authors provide a complete set of qualifiers, or “basic needs,” of health that can be researched further to understand where political, economic, and social structures interfere with sustaining and maintaining health and where health care is inadequate.

Health care should thus be understood as the system and structure that works to provide the above defined “basic needs” to each individual. Often this role falls to governments, but sometimes is taken up by communities and organizations when government’s fail to provide these basic needs.

This blog series will cover four key areas identified that will fuel this revolution in African health care: cooperative financing, para-professional training, information technology, and social enterprise. SCOUT BANANA works to tackle social medicine (social, economic, structures) while enabling others to provide medical services. Be sure to follow closely to learn more!

Written for the SCOUT BANANA blog.

The big question recently revisited, yet again, by the involvement of Oprah and Western celebrities conducting what some call “super-philanthropy”: is philanthropy good for Africa’s long-term development? My answer is yes, but a certain use of philanthropy. When the West tries to help the Rest (Africa) with a big fix or big plan there is most often failure and cynical backlash. Big plans do not work, as the economist William Easterly has helped me realize through his new book, The White Man’s Burden. He writes that the Planners need to give more power to the Searchers. Searchers being the people who look for the small-scale, community-based, effective projects that actually reach people in need. Searchers are the people on the ground implementing programs that actually get the $4 bed nets to families that need them and the easily accessable medicines for preventive diseases. I would categorize Oprah as a Planner, a celebrity Planner at that. She has heritage and roots in Africa and so she thinks she has a good reason to use her massive amounts of capital to shove solutions in the face of Africans.

On the BBC this question is asked and a dialogue has been opened to get the views of readers. One commenter thanks Oprah, but then says, “But you know what? Your deed is like throwing a gallon of water on the Sahara desert.” A beautiful metaphor for the Planners approach. What philanthropy needs is the opposite approach – pumping a gallon of water to the people in need of water in the Sahara desert. More effective investment philanthropy is needed if philanthropy in Africa is to get a better wrap. Many commenters expressed the thought that they would rather see no giving as opposed to seeing funds given to goverments. This takes us back to Searchers idea, give the funds to the people and organizations implementing effective programs that reach people.

This brings me back again to the work of the Acumen Fund supporting social entreprenuerial projects that are based in communities. Read one of the Acumen Fellows’ blog. Partners in Health implementing programs building health infrastructure in countries where the infrastructure is inadequate and in need of philanthropic support to reach people in need. As for the question, I believe that philanthropy is good for Africa’s long term development as long as it is directly aiding the people who truly need it. I cannot speak for a continent, but I would say Africa does not need celebrity Planners with big ideas to try misguided efforts. What Africa needs is a commitment by Planners to support searchers who are African and who are making sustainable advances for their communities. Likewise we need potential Western aid-givers, organizations, and foundations to work with African communities to invest in effective projects.

I highly recommend reading The White Man’s Burden by William Easterly to receive a great critique of Western aid agencies and efforts to aid. The book also gives a great presentation of what needs to be supported and implemented. It tells compelling stories of those who need the help and can benefit from the West’s effective philanthropy and engagement.