West African views of ethics and fairness in healthcare

African medical practitioners and disease control in Africa: an ethical anchor for a decolonial global health  
In an interview published by Science magazine on the 12th of June 2022, Tedros Ghebreyesus, the director-general of the World Health Organization (WHO), labelled the global COVID19 vaccine inequity “vaccine apartheid” and a “catastrophic moral failure” that has led to a “two-track pandemic.” Two years before the COVID19 vaccine imbroglio, the London School of Hygiene and Tropical Medicine published “LSHTM and Colonialism: A Report on the Colonial History of the London School of Hygiene & Tropical Medicine (1899– c.1960)” which acknowledges the colonial origins of the institution in a way that underlines the different valuation of lives characteristic of global health structures that led to vaccine nationalism by the Global North.   

LSHTM’s report joins growing efforts to decolonise global health structures and institutions through acknowledging the role of colonial history and power structures in global health. Yet these works, many of which are carried out in the Global North and centre Euro-American institutions, come at the expense of serious examination of the voices of Africans and specifically the roles that African medical practitioners (from colonial medicine, through to international global health) have played in challenging global health inequalities and ethics.   

Through historical case studies of yellow fever and schistosomiasis therapy and vaccination and control programs in Nigeria between the 1940s and 1970s, this paper takes African medical practitioners as a point of departure to examine how Africans have challenged the ethics of colonial and international health agencies.  

Fairness in Time: Generational experience and moral economies of state healthcare in Ghana 
In the years since independence from colonial rule in 1957, successive generations of Ghanaians have had different formative experiences of state-run healthcare – in terms of capacity and affordability under different governments, and in the just or unjust distribution of state health goods. Since the largely socialised system of health costs instituted by the first independent government of Kwame Nkrumah (1957-1966), before its removal by military coup, Ghana has seen a progression of partly-subsidised, fully out-of-pocket, localized or centralized, collapsed and restored systems of state care. At present, the country has a mixed system, with care and treatments costs partly covered by an ambitious National Health Insurance Scheme which began operation in 2003, but which faces disillusionment and criticism from many quarters.  

Beyond forgetting or nostalgia, the past remains a powerful referent in the present. The divergent historical experiences of different generations set particular limits on the range of morally acceptable actions and distributions within Ghanaian health, also constraining the range of possibilities for future healthcare reforms. 
Based on recent ethnographic, oral history and interview research with approximately 1,000 participants of different backgrounds, this presentation discusses how these formative historical experiences remain present in contemporary Ghana.  I examine how people draw on the past as a moral resource, to adjudicate questions of fairness in contemporary state care, and discuss how the formative healthcare experiences of different generations may shape their perception of current developments, with implications for the planning of fair coverage.