Innovation and urban health in Africa
Date and Start Time 30 June, 2017 at 09:00
This panel brings together historical and contemporary perspectives on innovation and urban health in Africa. It questions the nature and boundaries of innovation, asking how far innovation in health and healthcare has been, and continues to be, an urban phenomenon.
Urban areas are often assumed to be spaces of innovation for health and healthcare. The concentration of finances, education, specialist medical institutions, competition, and new technologies, as well as a greater mobility of population, have all been linked to the reshaping of care, knowledge, and practice. This assumption is rarely questioned, however, despite research that highlights the ways in which rural communities and institutions also employ innovative strategies to improve health and healthcare.
This panel investigates the pasts, present, and futures of urban health through the lens of innovation. It questions the nature and boundaries of innovation, asking how far innovation in health and healthcare has been, and continues to be, an urban phenomenon. How closely are innovations, such as those in community health initiatives, cancer research, sanitation projects, and service-user support programmes, tied to urban or rural spaces? To what extent have urban environments created distinct health challenges that have fuelled innovation, and have this been effective? And what is the relationship between urban and rural populations in the generation of health knowledge and practices?
Papers are invited from scholars and practitioners whose work offers new ways of approaching questions of innovation and urban health in Africa from historical or contemporary perspectives. Potential topics include, but are not limited to: colonial development schemes, medical research and training, systems of care, health education, digital technologies, and NGO projects.
Chair: Dr Yolana Pringle
This panel is closed to new paper proposals.
Health Planning and the developmental state in 1960s Africa
The paper examines five innovative WHO-led, USAID-funded national health plans in anglophone and francophone West and Central Africa, highlighting their concerns with management and distribution of health resources across urban and rural sectors, and assessing their successes, failures and legacy.
This paper is concerned with the conception, framing, innovation and reception of a series of national health plans in early post-Independence Africa. Originating in 1962 as a USAID-funded technical programme of the World Health Organisation (WHO), the exercise brought advisors, government bureaucracy, and fledgling post-colonial health sectors together to evolve national health plans in five African countries: Gabon, Liberia, Mali, Niger, and Sierra Leone. The exercise brought a growing concern with management and finance in health sectors to bear on problems of uneven resource distribution and urban skew in health provision in Africa, and drew on contemporary debates and developments in health planning across WHO regions globally.
The paper investigates what these planning exercises signified in the context of postcolonial global politics in the 1960s, what sort of development state the plans envisaged, and what forms of development the plans foreclosed or made possible. It traces the circulation of these plans, and the extent to which they overlaid an innovative and ultimately problematic infrastructural form - the developmental state in Africa - on existing patterns of urban and rural distribution of health resources. Finally, it highlights the specific forms of engagement that were envisaged and that emerged in the post-Independence state in Africa in the first decades of postcolonial sub-Saharan African history.
Imitation or Adaptation? Biomedicalizing Childbirth in Urban and Rural Uganda, 1918-2017
This paper will question the relationship between urban and rural innovation in the encouragement of women to deliver children in biomedical institutions, through an assessment of the expansion of midwifery services and maternal attendance in urban Kampala and rural northern Uganda.
In the 1920s, a network of maternal and child welfare centres began to spread across Uganda, emanating from two mission midwifery schools in Kampala. The city's midwifery schools sat at the centre of a network of maternity services, ostensibly innovating maternal and child welfare for the entire protectorate. In areas closely connected to Kampala, midwives achieved rapid success in founding new centres, and in attracting women to attend them for antenatal service. Initially, attendance for childbirth was very low, but by the 1950s, hospital deliveries began rising as rapidly as antenatal attendance had earlier. This paper will question to what extent this change was the result of political, socioeconomic, and chronological factors, and to what extent it was influenced by innovations in health education and healthcare delivery.
The paper will further this analysis by comparing the upswing of hospital births in central Uganda to much later, post-colonial upswings in hospital births in rural areas of Acholi and Karamoja that were never connected to the Kampala-centred network of midwives, but have a similar timeline of increased deliveries. It will question the relationship between urban and rural innovations in increasing delivery attendances, examining whether the increase in deliveries in rural northern Uganda was an imitation of patterns demonstrated as successful in Kampala and its environs, or whether rural midwives were innovating in response to the particular situation they were in. How, moreover, can we understand the ostensibly urban nature of health innovation when similar results often occur in rural areas decades later?
Reinventing toilets: Understanding urban innovations in sanitation, 2000-2015
This paper will examine innovations in approaches to sanitation services for public health, within the field of international development programming over the Millennium Development Goal (MDG) period. It will ask how innovation has differed in rural and urban settings and changed over the period.
This paper will examine innovations in approaches to sanitation services for public health, within the field of international development programming over the Millennium Development Goal (MDG) period (2000 to 2015). It will ask how innovation has differed in rural and urban settings and changed over the period. It will examine to what extent innovations have been able to transition from one setting to the other, how this process has influenced them, and to what extent they differ from historical examples of sanitation development for public health.
The paper will focus on the development of community-led total sanitation, originally a form of participatory development for rural villages in Bangladesh, but now implemented nationwide in many African countries and having undergone many adaptations (e.g. 'school-led total sanitation'; 'urban community-led total sanitation', 'CLTS+'). This will be contrasted with the technology driven approach to urban sanitation of the Bill and Melinda Gates Foundation's 'reinvent the toilet' campaign. This has been influential in refocusing the sanitation sector on on-site sanitation solutions for urban areas, and reconfigured the debate around faecal waste management, but has yet to provide a solution which reaches the scale of uptake of CLTS.
The paper will draw on academic and 'grey' literature describing the development of sanitation solutions and the challenges that have been experienced in attempting to achieve 'scale' and 'sustainability'. This will lead to a discussion of the socio-political and micro-economic characteristics determining the uptake or rejection of these innovations in different contexts.
L'argilothérapie : une innovation africaine (Côte d'Ivoire)
Un argilothérapeute ivoirien, qui exerce dans un hôpital de la capitale, élabore des compositions à base d’argile à des fins thérapeutiques. En quoi sa pratique, son savoir et ses «médicaments » sont-ils ou non une innovation dans le domaine de la santé et du soin en Afrique ?
Dans l'Unité de Médecine Traditionnelle, créée en août 2013 à Abidjan, un argilothérapeute reçoit de nombreux malades souffrant de maladies chroniques et de maladies métaboliques (hypertension, diabète, colopathie, arthrose). Fils de potiers, lui-même formé à la céramique, il devient argilothérapeute en 2009 et élabore des compositions à base d'argile à des fins thérapeutiques. Nous décrirons le contexte qui a vu naître cette pratique thérapeutique unique en Côte d'Ivoire, ainsi que l'histoire de la fabrication de ces « médicaments » à base d'argile (tisanes, crème, ovules, suppositoires). Nous interrogerons finalement le concept d'innovation dans le contexte de la santé. Ma présentation s'appuie sur une enquête ethnographique (réalisée lors de deux missions à Abidjan, en 2015 et en 2016).
This panel is closed to new paper proposals.