History of Health and Health Care Delivery Systems in Africa

Marcel Dreier & Pascal Schmid, Departement of History, University of Basel

Two dissertations grow out of this larger research project on the history of rural health systems in Africa. They describe and analyse the historical development of health care based on in‐depth studies of former mission hospitals and their peripheral services in Tanzania and Ghana. Using archival sources and oral testimonies, the dissertations link 20th century rural life and health practices to the politics of science and development.


Rural health care systems in many parts of Africa developed from mission medical services. In the course of the 20th century the politics and practice of health service provision were constantly reconfigured in relation to changes in economies, cultures and science. To understand these processes detailed historical accounts integrating colonial and post‐independence eras as well as social history and cultural and discursive approaches are very much needed.

Specific Objectives

These studies describe service provision and use in specific rural areas in Africa where Swiss Missions established extensive health services Ulanga & Kilombero districts in south‐central Tanzania; Ashanti–Akim North District in Ghana. The studies describe historical actors and analyse the changing character of health care and its rationales. Furthermore the case studies shed light on the long history of development practices.


From the level of institutions and their immediate environment we look at the larger forces that shaped how health systems worked, how they were understood and represented. We use previously unused archival documentation and oral testimony collected in Africa and Europe.

First Results

Changes in health services provision rarely resulted from straightforward program implementation but depended on configurations of power and their negotiation on local, national and international levels as well as on practices and traditions of specific health institutions.


Thesis M. Dreier: Health Care, Welfare, and Development in Rural Africa: Catholic health services in Ifakara/Tanzania in the 20th century
Thesis P. Schmid: Medicine, faith and politics in Agogo. A history of rural health care in Ghana, ca 1925 to 1980

Supervisor: Prof. Patrick Harries

Swiss National Science Foundation
Swiss Network for International Studies
Freiwillige Akademische Gesellschaft Basel FAG

Centre for African Studies Basel
Prof. Y. Lawi & F. Kaijage, University of Dar es Salaam
Prof. K.A. Senah, Department of Sociology, University of Ghana

Duration: April 2008 ‐ December 2011

Download Poster: History of Health and Health Care Delivery Systems in Africa (2012)


Keywords: Tanzania, Ghana, history of health care, medicine, development, mission

Link: Research Group at Department of History, University of Basel