Why Justice is Good for Healthcare in Africa: Towards an Ethical framework

Abstract

This chapter aims to establish the place of justice in the discourses on and outlooks of health and healthcare in Africa. It anticipates a specific African approach of justice in the distribution of and access to healthcare. African countries, south of the Sahara, are widely recognised to share a common cultural heritage in which communitarian ethical values are emphasised. Among other things, they also share a similar burden of disease. In the region, communicable diseases constitute approximately 50% of the leading causes of deaths. While Africa bears a relatively high proportion of the global burden of disease, financial commitment to healthcare amounts to less than 2% of the total global expenditure. This results in high rates of household out-of-pocket payments. Yet, over two-thirds of Africa’s populations live below the acceptable poverty benchmark. These facts raise questions of justice for healthcare in Africa, especially relating to ethical issues surrounding distribution and access. While questions of healthcare justice abound, much of the discourse in bioethics in Africa mostly focuses on research ethics (e.g. involving patients in clinical trials). Relevant debates are often limited to questions of autonomy and informed consent. Furthermore, global Bioethics has largely avoided questions of health inequalities in Africa. Various efforts in healthcare reform exclude ethical measures in reviewing the system and analysing health policies. The chapter envisions a framework of justice for healthcare that should more appropriately guide ethical reforms in African health systems.