Health Planning in 1960s Africa: International Health Organisations and the Post-Colonial State

Abstract

This article explores the programme of national health planning carried out in the 1960s in West and Central Africa by the World Health Organization (WHO), in collaboration with the United States Agency for International Development (USAID). Health plans were intended as integral aspects of economic development planning in five newly independent countries: Gabon, Liberia, Mali, Niger and Sierra Leone. We begin by showing that this episode is treated only superficially in the existing WHO historiography, then introduce some relevant critical literature on the history of development planning. Next we outline the context for health planning, noting: the opportunities which independence from colonial control offered to international development agencies; the WHO's limited capacity in Africa; and its preliminary efforts to avoid imposing Western values or partisan views of health system organisation. Our analysis of the plans themselves suggests they lacked the necessary administrative and statistical capacity properly to gauge local needs, while the absence of significant financial resources meant that they proposed little more than augmentation of existing structures. By the late 1960s optimism gave way to disappointment as it became apparent that implementation had been minimal. We describe the ensuing conflict within WHO over programme evaluation and ongoing expenditure, which exposed differences of opinion between African and American officials over approaches to international health aid. We conclude with a discussion of how the plans set in train longer processes of development planning, and, perhaps less desirably, gave bureaucratic shape to the post-colonial state.

Keywords: Africa; Development; Health systems; Planning; World Health Organization.

Figure 1:

Milton Siegel (left); John Karefa-Smart (right), leading officials of the WHO active in the debate on the evaluation of the Africa health plans. (Left: WHO Archives photo ref. WHO_14661 – Caption: Milton P. Siegel, Assistant Director-General of WHO. © World Health Organization/Tibor Farkas. Right: WHO Archives photo ref. WHO_11980 – Caption: Dr John Karefa-Smart, Assistant Director-General of WHO. © World Health Organization/Tibor Farkas.)