Swiss Society for African Studies publication

African innovations in the healthcare sector have recently started to attract more attention. In Sierra Leone, for instance, the state is providing free healthcare for children and pregnant women, while in Rwanda, the vaccination of girls against, and screening of older women for the human papillomavirus is fast making this small African state likely to eliminate cervical cancer long before the US—a point recently made in a New York Times article entitled “What We Can Learn From ‘S-Hole Countries’” (2018). 

In June 2019, an interdisciplinary research project investigating African knowledge production, practices and innovations in the field of public health was jointly launched by the Department of History, University of Basel, the Swiss TPH and the Communauté d’Études pour l’Aménagement du Territoire (CEAT) at the EPFL. The project brings together an international team of researchers with expertise in African history, veterinary and human epidemiology, health economics, pharmaceutical medicine, environmental engineering and urban planning. Based on the foundational hypothesis that innovations from the south are beneficial beyond their place of origin, it will examine bodies of knowledge, practices, applications or technologies that were shaped by African actors—medical personnel, experts, local populations—or that emerged through international cooperation in specific sites in Africa. It will ask how these have the potential to become decisive to questions of health on a broader scale, or have indeed already been taken up in global (public) health discourses. 

In the last two decades, for instance, many African governments have been experimenting with the design of their healthcare systems and financing models, with potentially important lessons for both the South and the North. Urban agriculture, which is practiced across the continent and contributes significantly to urban dwellers’ food access and nutritional diversity, is another site of innovation. Incorporating it systematically in urban planning has the potential to benefit the health of urban populations across Africa and beyond. Another area of major innovation is drug development. Given that conventional drug development processes were found to not be financially viable for many neglected tropical diseases in low-income settings, new product development partnerships (PDPs) have been created to find effective solutions for major health problems within limited budgets. Furthermore, ‘OneHealth’, a movement stressing the integrated nature of human, veterinary and environmental health, has greatly impacted global health debates—yet the East African origins of this concept have been overlooked. 

The project African Contributions to Global Health will investigate these and other cases. In this way, it will engage critically with debates on knowledge production, circulation and innovation. The four years’ project, funded by the SNSF Sinergia funding tool, is headed by Julia Tischler (Department of History, University of Basel) along with Jérôme Chenal (EPFL, Lausanne) and Jürg Utzinger (Swiss Tropical and Public Health Institute, Basel). The team further comprises two postdoctoral researchers, four PhD students, and project partners based in Cote d’Ivoire, Zambia, Tanzania, Kenya and Switzerland. 

Through six closely interlinked subprojects, researchers will examine three central areas of health in the period after the Second World War to the present: drug development, healthcare systems, and environmental health and holistic approaches to healthcare. 

Tanja Hammel is a historian who focuses on the emergence, the role and the impact of collaborative work between public and private partners in the research and development of medicines for so-called ‘tropical diseases’. Specifically, she will investigate clinical trials for the antimalarial drug mefloquine, which were conducted at the Tropical Disease Research Centre in Ndola, Zambia, from the mid-1970s to the 1990s. Hammel’s PhD in African History from the University of Basel received critical acclaim for its examination of plant, animal and ecological knowledge production in nineteenth century South Africa. 

Eric Ipyn Nebie is a medical specialist in tropical medicine and vaccinology, who brings extensive working experience in his native Burkina Faso to this project. His subproject in public health and epidemiology will investigate processes of drug development, comparing current modes of operation in the pharmaceutical industry in the north with approaches to the development of medicines against neglected tropical diseases in the South. By comparing the modalities of ‘conventional’ for-profit pharmaceutical research in high-income countries with models used by non-profit Product Development Partnerships and academic research in, for instance, Tanzania, he will seek to identify cost-saving mechanisms and possible sources of over-expenditure, thus pointing to tangible saving potentials in pharma-based research, as well as possible shortcomings in other modalities. 

Doris Osei Afriyie has worked on health systems and services in Vietnam, Zambia and Ghana. Before joining this project, she was the technical officer for health strategies, policies and governance in the WHO regional office for Africa in Congo-Brazzaville. Her subproject is located at the intersection of Public Health and Economics. Its point of departure is the context of constant pressure on African governments to improve healthcare infrastructure and reduce their dependence on external support for the implementation of health programmes. This has led to the adoption of a range of new and innovative healthcare and financing models in the last two decades, with African countries essentially becoming the global testing ground for health systems reform. This subproject will systematically review recent health system reforms in Tanzania and Zambia, with a specific focus on health insurance and on performance-based contracts for facilities and investigate their implications for high-income countries. 

Vitor Pessoa Colombo’s subproject in Urban Planning proposes to explore the relations between this discipline and public health by mapping the distribution of health outcomes and assessing their possible relations to environmental factors, focusing on the built environment. Before joining the project, Pessoa Colombo worked as a GIS specialist at the Observatory for Spatial Development (Università della Svizzera Italiana), where he developed GIS tools adapted to the context of slums in low/middle income countries. His subproject situates urban planning in the global health agenda by reassessing the relevance of urban planning as a tool to promote health equity through the prevention of disease. It will investigate the relations between water-related diseases and different aspects of the built environment in Nairobi and Abidjan, where innovative water and sanitation solutions have recently taken place. 

Akuto Akpedze Konou’s subproject in Urban Planning will investigate the complex relationship between urban agriculture, health and spatial planning. Given local pressures regarding food security and population, African cities have become sites of experimentation and innovation in urban agricultural practices—yet urban planning has largely ignored urban agriculture. This project will seek to build a typology of urban and peri-urban agriculture, focusing on Nairobi and Dar es Salaam. Konou is a registered architect who has trained and worked in Togo, Benin, Nigeria and, most recently, as a Fullbright Scholar in the USA. 

Danelle van Zyl-Hermann’s subproject focuses on the epistemological foundations and practices underlying the emergence of the public health sector in post-war Kenya. It seeks to assess how knowledge was negotiated between colonial, national and international actors in dialogue with Kenyans, and the possible feedback this had on global health debates, against the backdrop of the shift from late-colonial developmentalism, through post-independence health priorities and policies, to the phase of structural adjustment. Through various case studies of knowledge encounters, sites of practice, and key figures, she will investigate questions of power and agency, medical pluralism, and epistemological contestation, cross-pollination and integration. Van Zyl-Hermann comes to this project with a background in the social and labour history of South Africa with a close focus on the relationship between subaltern actors and the state. She holds a PhD in History from the University of Cambridge. 

Through these various subprojects, and in collaboration with its African project partners, this research aims to develop an interdisciplinary perspective on health and innovation from an Africanist viewpoint. By bringing heterogeneous notions of knowledge and innovation in different disciplines into conversation and practice, this will significantly enrich academic debates on the production and circulation of health-related knowledge. Beyond the scholarly arena, the project will also help facilitate policy formulation and decisions regarding healthcare through meetings with stakeholders in public health, including urban planners, administrators, development experts, politicians and public health experts. In addition, workshops, PhD coaching meetings, and two international conferences will allow the on-going engagement between researchers. The project will also contribute to teaching in the various disciplines concerned, including a joint Massive Open Online Course (MOOC). Interested parties are warmly invited to contact those involved and visit www.globalhealthafrica.ch to stay abreast of the latest events, opportunities and publications.