History of Health Systems in Africa: Swiss mission hospitals and rural health delivery in the 20th century

Patrick Harries

Beginn: 01. Mai 2008
Abschluss 30. Sep 2011

Given the enormous importance of health to the wellbeing of humans, the history of health systems in Africa is heavily under-researched. With the end of colonialism, the development of health systems became a prime duty for independent African states and a matter of international concern. At this time a ‘demedicalization’ of health services accompanied a new stress on public health and greater equity in service delivery. Neglected by governments during most of the colonial era, the development of rural health care is a central aspect of these tasks. Mission societies were the first - and for a long time the prime - providers of health services in rural areas. Rural health care in many African countries today relies on hospitals, clinics and dispensaries established by missionary societies. This project will attempt to explain some of the successes and failures of these institutions by comparing the history of medical services provided by various hospital complexes founded by Swiss missionaries in rural Africa.

Health systems

This project will not concentrate on the individual medical missionary and his ‘magic bullets’ but will instead focus on a history of systems and their capacity to deliver health. In this sense we attempt to conceptualize how ‘the gun’ works that both fires the bullet and is responsible for its direction and momentum.Comparison: The study’s design is based on examples drawn from very different countries in Africa. The data comes mainly from three case studies: Elim Hospital in South Africa (founded by the Mission romande or, after 1927, the Swiss Mission), Ifakara in Tanzania (founded by Benedictines and Capuchins) and Agogo (established the Basel Mission). The main results will be produced in the course of analysis of the case studies in a comparative framework (built on a chronological structure which adresses a specific set of research questions)
By looking at both textual and oral Swiss missionary sources and sources related to health delivery by church organisations we make use of a rich body of under-researched material. Added to this will be research into government and health organisations sources in Africa, as well as an extensive oral history approach in Switzerland and in the countries where case studies are conducted.
Identification of actors in health systems and their perspectives
Characterisation of health care concepts and delivery in rural Africa
Assessing and explaining success and failure in health care provision in a historical perspective
Describe and specify characteristics of mission-medicine
Quantitative data: collection, epidemiological analysis and assessment


Zentrum für Afrikastudien Basel, Schweizerisches Tropeninstitut, Ethnologisches Seminar Basel


Marcel Dreier: Health Care, Welfare and Development in Rural Africa: The Case of the Catholic Health Services in Ifakara/Tanzania in the 20th Century

Pascal Schmid: Medicine, Faith and Politics in Agogo: A History of Rural Health Care in Ghana (ca. 1925 to 1990)