Making and Unmaking Public Health in Africa: ethnographic and historical perspectives ed. By Ruth J. Prince and Rebecca Marsland, and: Scrambling for Africa: AIDS, expertise, and the rise of American global health science by Johanna Tayloe Crane (review)

The two books under review here make a useful contribution to understanding the changing public health sector in Africa. The edited volume by Prince and Marsland is a critical reflection on new forms of public and global health. The economic recession during the 1980s and the aggravated AIDS crisis in many African states led to the massive influx of Western NGOs, the privatization of hospitals and medical services, and the engagement of international research funds such as PEPFAR (the US President’s Emergency Plan for AIDS Relief) and other humanitarian institutions. This situation is the starting point for the editors to discuss the influence of markets, biotechnologies and pharmaceutical companies on social relations, medical care and new forms of citizenship. The volume by Johanna T. Crane ties in with these problems. She offers a detailed case study of a transnational research centre and clinic in Western Uganda under similar socio-economic conditions.

In her knowledgeable introduction, Ruth Prince brings to the fore the difficult trajectory of African healing from precolonial times to the neoliberal twenty-first century. The great merit of this introduction lies not only in the richness of its historical data and its socio-economic contextualization but also in the analytical gaze that discerns the entanglement of public medicine with historically different hierarchies of power and wealth. All three parts of the volume shed light on different aspects of public health, its dynamics of change and deep entanglement with foreign donors. The first part deals with the relationship between public health and the postcolonial state. Whereas government officials in Northern Nigeria try to profit politically from the presence of public health centres (see the chapter by Last), in Tanzania, officials challenge seemingly irrational and backward traditions at funerals and other social events by imposing rational by-laws (Marsland). Both chapters emphasize the existence of very different, if not antagonistic, conceptualizations of the public and of public health. Historically, public health was part of the religious and moral order of African societies, being firmly rooted in collective social and political relationships. These ideas contradict the present emphasis on individual responsibility for one’s health and explain why a great majority of the population remains rather sceptical about modern forms of biopolitics. That these attitudes, however, do not lead to passive or just observant behaviour but can generate constructive recommendations by self-conscious citizens is the tenor of Tousignant’s chapter. Because of the increase in pharmacy thefts, linked to illicit markets and outsourcing of production, Senegalese pharmacists reminded the government of its duty to uphold standards and control for the public good. Their enactment of a ‘citizenship of quality’ (p. 97) underlines their professional responsibility in times of the illicit trading of drugs and is interpreted as a renewal of the contract between the state and its professional elites.

The second part of the book is characterized by detailed case studies of care whose difference in quality is related to the influx of foreign-dominated home-based AIDS care institutions (HBAC) in comparison to government services. The free distribution of ARVs (antiretroviral medicines) has tremendously improved the life of AIDS patients, who, in return, have to follow strict regulations of drug taking and food control. In her case study, Meinert describes the tension that results from the social role of being a patient and the wish to become a...