The paper abstract is here, with the panel abstract below:
´Into the Hitherto untouched Periphery’: Planning, Primary Health Care and Changing Idioms of Health Governance in Ghana
This paper traces the trajectory of Primary Health Care (PHC) – under various names and varied reimaginings by successive cohorts of health officials – as an idea shaping both domestic planning and the relationship of Ghana’s health system to the world of ‘international health’. The discussion covers the period from 1957-1996, through independence, decades of rapid political change, the turn to structural adjustment, and Ghana’s return to multi-party democracy in 1996. The paper notes the singular role played by the WHO in assuming authority for health planning after 1966, following the overthrow of the first independent African government. It examines how this role was progressively eroded from the late 1970s, by the rise of alternative international health actors and the simultaneous reassertion of an uneven domestic sovereignty for healthcare decision-making. It asks what these developments have meant for the subsequent evolution of Ghana’s national health services.
Panel: ‘Primary Health Care’ in Post-War Global Health: Making and Meaning
The concept of Primary Health Care (PHC) gained traction in the later twentieth century as the ideal model for extending basic health coverage to poorly served populations. The term seems to have originated in interwar Britain, where it denoted both a set of services - general practice medicine in ambulatory, office or community settings - and the notion of ‘first contact’, in an integrated system with hierarchies of skilled care. New forms of PHC began to emerge in different contexts in the Global South at least from the 1960s, then made their way into the health planning initiatives of international health organisations. They responded to the inadequacy of Western forms of biomedical services premised on urban hospitals and limited dispensaries, which had been a legacy of colonial or hegemonic rule. Aiming to reach poor, rural populations with low-cost, effective technologies, PHC also signified new practices, like the use of traditional healers and the incorporation of health with broader development programmes. In 1978 it was adopted by the WHO and UNICEF as the flagship policy for achieving ‘Health For All’, though standard narratives of global health history suggest this soon lost momentum, in favour of disease-specific programmes of proven cost-effectiveness. In 2018 the commitment to PHC was reaffirmed by WHO and UNICEF in the quest to fulfil the United Nations’ goal of Universal Health Coverage by 2030.
For historians of global health, questions concern the origins and context of these different models of PHC, the ways in which they were taken up in the policy discourse of international health organisations, and the explanations for their success or failure over a long period, during which many people manifestly continued to lack access to appropriate health services. Overlaying these are larger questions about the dynamics of powe in the negotiated relationship between North and South, core and periphery, and the sorts of transnational vectors determining the flow of ideas and innovations that shaped new models of health care delivery. This panel asks: to what extent has neo-colonialism and the exercise of soft power been a determining factor in the patterns of aid and adoption of innovative grassroots models? To what extent did PHC implementation and innovation occur with reference to local political, economic and social factors, without regard to the Western ‘development’ project? How did distinct networks of actors influence the outcomes of PHC policies at international, national and sub-national levels ?
The papers in this session aim to address these questions with case-studies from four settings: Nigeria and Ghana, as examples of newly independent African nations seeking to build novel health planning from the limited infrastructure of colonial health services; Colombia, as an established centre of regional innovation tightly networked with American foundations and international organisations, but where sustainability proved challenging; and New Zealand, as an example of a wealthier post-colonial society looking to transnational and local ideas to extend PHC to poor and indigenous populations.