Saturday, October 17, 2009

Have NGOs replaced the State in African Health Care Provisioning?

At the time of independence, many African countries aspired to provide western-style welfare state social provisions by providing free medical care and free university education and other social services to their citizens.
The prevailing political currents of socialist ideology around the globe in the 1960s occasioned by the cold war brought to birth the idea of ‘African socialism’ which in its crudest forms emphasized the sense of ‘African community’ and therefore the concept that ‘everybody’s welfare was everybody’s business’. In East Africa, Ugandan Prime Minister Milton Obote unveiled the ‘common man’s charter’ a socialist manifesto for newly independent Uganda. In Tanzania, President Julius Nyerere gave credence to ‘ujaama’ villages or communal villages that provided an all embracing community.
Social services were freely provided and medical services at government hospitals were free as were other social provisions.
However in the early 1980s the idea of an ‘African’ welfare state came under serious threat as being unsustainable owing to failing economies under hardship due to falling international prices of the cash crops on which many African countries depended coupled with chronic political turmoil and ethnic tensions ubiquitous in post independence Africa.
African countries, and Uganda in particular, sought budget deficit financing from the World Bank and the International Monetary Fund (IMF).
The Breton Woods institutions prescribed the hugely unpopular Structural Adjustment programmes (SAPs) that called for radically reduced social spending in the social sectors of health and education by the introduction of ‘user fees’ and ‘cost sharing’ in social service provision as well as the full-scale marketization of social provisioning.
The introduction of market liberalization reforms, including privatization of the social sector, has turned citizens into client-consumers rather than social provision beneficiaries with millions falling through the cracks.
The prolonged diminished fiscal ability of the Ugandan state to provide social welfare has seen an increasing importance of non -governmental agency providers of health care. In sectors such as HIV/AIDS health care and treatment in Uganda, non governmental and civil societal organizations dominate. Hence the failure of the state and the market in Uganda has seen the emergence of new service providers and the expansion of space for alternate players. The central question would therefore be that has the ‘pluralism’ of social welfare providers in Uganda called into question the need for a paradigm shift to a tri-model of state, market and civil society?

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