LSE-UCT July School 2015
Health, History and Human Rights in Africa –
A Case Study of the Struggles for Primary Health Care
Course Outline and Reading List
Instructors
Prof. Steve Reid, Chair of Primary Health Care, Primary Health Care Directorate, University of Cape
Town
Steve Reid is a Family Physician with extensive experience in clinical practice, education and research
in the field of rural health in South Africa. Having completed his medical training at UCT, he served as
a medical officer for 10 years at Bethesda Hospital in north-eastern KwaZulu-Natal, initially as a
conscientious objector to military service in the 1980’s. He was involved in community initiatives in
health in the Bethesda health ward, and later established a Vocational Training Programme for rural
doctors at McCord Hospital in Durban. As director of the Centre for Health and Social Studies
(CHESS) at the University of Natal, he took responsibility for community-based education and rural
health at the University of KwaZulu-Natal. He teaches undergraduate and postgraduate students in
public health, family medicine and health promotion, around the theme of Community-Oriented
Primary Care (COPC). As Chair of Primary Health Care (PHC) at the University of Cape Town since
2010, he heads a Directorate that implements PHC as the faculty’s lead theme. His inaugural address
at UCT in 2011 was entitled: “The Music of Health for All”. An active musician, playing the violin and
piano, he integrates the expressive and creative arts into his teaching and research, and is helping to
develop the medical humanities as a sustainable theme in the Faculty of Health Sciences.
Dr Carla Tsampiras, Senior Lecturer in Medical and Health Humanities, Primary Health Care
Directorate, University of Cape Town
Carla Tsampiras is an historian who is continuing her evolution as a researcher and lecturer at UCT as
the country’s first Senior Lecturer in Medical Humanities. Carla is a feminist social historian of health
who is particularly interested in how constructions of gender, 'race', and sexuality have shaped
research into health and access to healing. Her PhD examined early responses to AIDS in South Africa
(1980- 1995) by medical elites, politicians, freedom fighters, and health care workers. Her other
research interests include the relationships between health, dis-ease and society; social histories of
HIV and AIDS in South and Southern Africa; slavery (past and present); gender and violence; global
social justice issues; and the opportunities medical and health humanities could provide to
reimagining health concerns. In addition to being an historian she is also a vegan and a qualified
Sivananda yoga teacher.
Associate Professor Susan Levine, School of African and Gender Studies, Anthropology and
Linguistics, University of Cape Town
Susan Levine is an anthropologist and lecturer at UCT. Perhaps best known for her work on a media
intervention campaign to combat the stigma related to HIV/AIDS, Susan’s other research interests
include work on visual culture, the anthropology of children and medical anthropology. Funded by
the NRF, Susan supports six postgraduate students who variously work on the impact of xenophobia
among child refugees, water-borne illness among children in informal settlements, chronic care
facilities for children with terminal illness, children and HIV/AIDS, the question of international
development projects for children, and children living with cancer. She has recently published her
first monograph, Children of a Bitter Harvest: Child labour in the Cape Winelands (2013).
Course Summary
As the World Health Organisation notes ‘the ultimate goal of primary health care is better health for
all’ to be achieved through ‘reducing exclusion and social disparities in health (universal coverage
reforms); organizing health services around people's needs and expectations (service delivery
reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of
policy dialogue (leadership reforms); and increasing stakeholder participation’. But how do different
countries experience and further these ambitious goals, why are they important, and how do the
histories that characterize local and global interactions influence the achievement of these goals?
In this course, participants will gain insight into the often tumultuous stories that have shaped
ideologies, access and understandings of health in South Africa, as a case study of a developing
nation in Africa. Participants will also gain insight into the current South African health care system
and the challenges and inspiring solutions that are going into realising health care for all. They will
also explore the significance of ideas around social accountability, social justice, human rights, and
medical and health humanities in health sciences education.
Course Structure
Each day is divided into three sessions: Two morning sessions separated by a tea break; and an
afternoon session that may be a tutorial, practical or other activity. Attendance and participation in
all class sessions is mandatory.
Course Overview
Session 1: Wamkelekile (Welcome) and Introduction
This session will provide an overview of the course, allow for introductions, and include a discussion
of expectations and interests of participants. Further information on readings and course
requirements will be provided.
Required readings:
a) EQUINET NEWSLETTER 169: 01 MARCH 2015 available from the Equinet website at
www.equinetafrica.org/newsletter.
b) Participants should also spend some time browsing back issues of Equinet Newsletters and
identifying themes or aspects of health care that they are most interested in.
c) The Introduction to Global Health Watch 4 available at the Global Health Watch (GHW)
website at www.ghwatch.org/sites/www.ghwatch.org/files/GHW4_Introduction_0.pdf .
d) Participants can find additional information on the content of GHW 4 at
www.ghwatch.org/node/45470 .
e) Chapter A1 – ‘Economic Crises and Systemic Failure: Why We Need to Rethink the Global
Economy’ in Section I: The Global Political and Economic Architecture of Global Health
Watch 3 available at www.ghwatch.org/sites/www.ghwatch.org/files/A1.pdf .
f) Chapter B7 – ‘Research for Health’ in Section II: Health Systems - Current Issues and Debates
of
Global
Health
Watch
3
available
at
www.ghwatch.org/sites/www.ghwatch.org/files/B7.pdf .
g) Each participant must also select one additional chapter from any of the sections of GHW 3
(Section II: Health Systems – Current Issues and Debates; Section III: Beyond Health
Care; Section IV: Watching; and Section V: Resistance, Actions, and Change) available at
www.ghwatch.org/node/547 . At the introductory sessions participants will be asked to
briefly talk about the main arguments of the chapter and why they chose to read it.
Session 2: Health, Dis-ease and Society
Historical Perspectives on Health Care in South Africa – contemporary discussions about who to
provide health care to, how to provide it, and how to pay for it, are shaped and influenced by the
overlap of histories, economics, politics and society . This session highlights the ‘dis-ease’ that has
often characterised the relationship between health and society.
Required readings:
a) Marks, S., 'South Africa's Early Experiment in Social Medicine: Its Pioneers and Politics',
American Journal of Public Health, 87, 3, March 1997.
b) Marks, S., & Andersson, N., ‘Apartheid and Health in the 1980s’, Social Science & Medicine, 27,
7, 1988.
c) Marks, S., & Andersson, N., ‘The State, Class, and the Allocation of Health Resources in
Southern Africa’, Social Science & Medicine, 28, 5, 1989.
d) Phillips, H., ‘AIDS in the Context of South Africa’s Epidemic History: Preliminary Historical
Thoughts’, South African Historical Journal, 45, 1, November 2001.
Session 3: Deliberate Exclusion and Sanctioned Disparity
Scientific Racism, Scientific Sexism, Apartheid and Health – a discussion about the many subjective
ideas that have shaped ‘objective’ health care research and health provision in metropoles, colonies
and other contested spaces.
Required readings:
a) Marks, S., 'An Epidemic Waiting to Happen? The Spread of HIV/AIDS in South Africa in Social
and Historical Perspective', African Studies, 61, 1, 2002.
b) Phillips, H., ‘AIDS in South Africa: An Historical Perspective’, Society, 40, 4, May/June 2003.
c) Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D., ‘The health and health system
of South Africa: historical roots of current public health challenges’, Lancet, 374, 2009,
pp. 817–34.
d) Tsampiras, C., ‘“Not So ‘Gay’ After All’: Constructing (Homo)sexuality in AIDS Research in
the South African Medical Journal, 1980 – 1990’, Southern African Historical Journal,
60, 3, 2008.
Session 4: ‘Terrorists’, AK’s and AIDS
Early Responses to AIDS in SA and Recent Responses to Ebola – health crises past and present have
often had to be negotiated in numerous contexts and often volatile political circumstances. This
session looks at early responses to AIDS by a then liberation movement and explores what lessons
can be learned when examining more contemporary health crises like Ebola.
Required readings:
a) Armstrong, M., ‘Healthcare in Exile: ANC Health Policy and Health Care Provision in MK Camps,
1964 to 1989’, South African Historical Journal, 66, 2, April 2014, pp. 270-290.
b) Tsampiras, C., ‘Sex in a Time of Exile: An Examination of Sexual Health, AIDS, Gender and
the ANC, 1980 – 1990’, Southern African Historical Journal, 64, 3, September 2012,
pp. 637-663.
c) Sanders, D., Sengupta, A. & Scott, V. ‘Lessons to Learn from Ebola Outbreak’, Cape Times
(South Africa), 22 December 2014 available on IOL website at
http://www.iol.co.za/news/lessons-to-learn-from-ebola-outbreak-1.1798246#.VQGJOEXXHc.
d) Wright, S. & Hanna, L., ‘A Wake-up Call - Lessons from Ebola for the World’s Health Systems’,
Report
by
Save
the
Children
available
on
their
website
at
http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0df91d2eba74a%7D/WAKE%20UP%20CALL%20REPORT%20PDF.PDF .
Session 5: The Contemporary South African Health System
Examining health and health care provision requires an awareness of the complicated relationships
between global, regional, and local socio-political, historical and economic factors. This session uses
the contemporary South African health system as a case study to explore some of those complex
factors. (This session includes a field trip to a Community Health Centre in Khayelitsha).
Required readings:
a) Health in South Africa. Lancet Series, 2009. http://www.thelancet.com/series/health-in-southafrica
b) Mayosi B, et al. 2012. Health in South Africa: changes and challenges since 2009. Lancet 380
(9858): 2029-2043.
http://www.sciencedirect.com/science/article/pii/S0140673612618145
c) Browse the South African Health Review 2013/14. Health Systems Trust, Durban, 2014.
http://www.hst.org.za/publications/south-african-health-review-201314
d) Benatar, S R. The challenges of health disparities in South Africa. South African Medical
Journal, [S.l.], 103 (3): 154-155, 2013. ISSN 2078-5135.
http://www.samj.org.za/index.php/samj/article/view/6622/4918
Session 6: Community-Oriented Primary Care, Health for All, and the National Health Insurance
This session will examine some of the key ideas that have shaped some recent thinking on health
care and look at how they have been applied (or will be applied) to health care in South Africa. Key
ideas around primary health care and ‘putting people first’ have been central to global discussions
about health care.
Required readings:
a) World Health Organization, 2008. Putting People First: Chapter 3 in: World Health Report
2008. Primary Health Care: Now More Than Ever”. Geneva, 2009.
http://www.who.int/whr/2008/chapter3/en/index.html
b) Longlett SK, Kruse JE, Wesley RM. Community-Oriented Primary Care: Historical Perspective. J
Am Board Fam Pract 14(1):54-63, 2001.
http://www.jabfm.org/content/14/1/54.full.pdf+html?sid=d6643818-c705-4bc0-b89e2b5b27fb7165.
c) Chapter B1 'Primary health Care: A Review and Critical Appraisal of its "Revitalisation"' in
Global
Health
Watch
3
available
at
http://www.ghwatch.org/sites/www.ghwatch.org/files/B1_0.pdf .
d) National Health Insurance in South Africa: Policy Paper. Department of Health, Pretoria, South
Africa. http://www.gov.za/sites/www.gov.za/files/nationalhealthinsurance.pdf .
e) Browse the National Health Insurance South Africa website at http://www.nhisa.co.za .
Session 7: Health and Social Movements in South Africa
Health and social movements have been vital in exposing hierarchies of power and privilege in
health care provision and access. They have also helped shape (and sometimes re-shape) the health
care landscape as this session will discuss.
Required readings:
a) Ballard, R., Habib, A., Valodia, I., & Zuern, E., 'Globalization, Marginalization and
Contemporary Social Movements in South Africa', African Affairs, 104, 417, October
2005, pp. 615-634.
b) Friedman, S., & Mottiar, S., 'A Rewarding Engagement? The Treatment Action Campaign and
the Politics of HIV/AIDS', Politics & Society, 33, 4, December 2005, pp. 511-565.
c) People's Health Movement - South Africa website at http://phm-sa.org/ .
d) Mandisa Mbali, South African AIDS Activism and Global Health Politics (Palgrave Macmillan,
2013).
Session 8: The Social Accountability of Health (Medical) Education
In an age of globalisation, what is required of health professionals and those who educate them?
What is the point of health education and how do we link it to social accountability in a global
system that seeks to atomise and individualise rather than work collectively and act in solidarity?
Required readings:
a) Celletti F, Reynolds TA, Wright A, Stoertz A, Dayrit M (2011) Educating a New Generation of
Doctors to Improve the Health of Populations in Low- and Middle-Income Countries.
PLoS Med 8(10): e1001108. doi:10.1371/journal.pmed.1001108
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001108
b) Global Consensus for Social Accountability of Medical Schools.
http://healthsocialaccountability.org/
c) Frenk, J, Chen, L, Bhutta, ZA et al. Health professionals for a new century: transforming
education to strengthen health systems in an interdependent world. Lancet. 2010; DOI:
http://dx.doi.org/10.1016/S0140-6736(10)61854-5
Session 9: The Medical and Health Humanities – A New Way of Knowing?
The ‘Medical Humanities’ have been discussed and debated in certain English-speaking areas of the
world (the ‘North’) for over a decade, but there is a new energy and interest in this field from
countries in ‘the South’ who are interested in exploring if a reimagined notion of the field might
result in ‘new ways of knowing’ and understanding health.
Required readings:
a) Holden, Kieffer, Newbigin, Wright (eds.) ‘Where does it hurt? The New World of Medical
Humanities’, Wellcome Trust. http://wellcomecollection.org/wheredoesithurt
b) Brody, H., ‘Defining the Medical Humanities: Three Conceptions and Three Narratives’, Journal
of Medical Humanities, 32, 2011, pp. 1 – 7.
c) Atkinson, S., Evans, B., Woods, A., & Kearns, R., ‘”The Medical” and “Health” in a Critical
Medical Humanities’, Journal of Medical Humanities, 36, 2015, pp. 71–81.
d) Campo, R. ‘“The Medical Humanities,” for Lack of a Better Term’, JAMA, 294, 9, 2005; pp.
1009-1011.
Session 10: Summary and Conclusions
In this session participants will reflect on what has been discussed, think about key points and
themes that emerged during the course, and consider what conclusions can be drawn from the
course.