Countries in Sub-Saharan Africa share at least three things: cultural heritage, a high
burden of disease and a low financial commitment to health care. This thesis asks
questions of justice about health care systems in Sub-Saharan Africa, in particular
Nigeria. The questions are about access to the available health resources and
services within African health care systems. While the sub-region as a whole cannot
boast of good health care, certain population groups are relatively more
disadvantaged. This suggests either or both of two problems: a) that access to basic
health care is not proportionate to the populations’ needs; and/or b) that the
distribution of the available health care resources favour some over others.
Attempts to improve population health have focused on empirical, economic or
social strategies. These tend to overlook the ethical dynamics surrounding access to
and the distribution of health care. In view of this moral challenge, Norman Daniels
has proposed the ethical framework of Accountability for Reasonableness, which can
provide basic guidelines for just health care reforms in Africa. While his approach
has been effective in the United States, the theoretical basis has fundamental value
differentials from African ideals of justice.
Starting from Daniels’ Just Health – Meeting Health Needs Fairly, this PhD study
develops an African ethical framework that could inform reforms in African health
care systems. Specifically, it establishes four key attributes of the African moral
outlook, and three principles of African justice. It further abstracts an African
method of ethical analysis: process equilibrium. Against this background, the thesis
develops a harmonised framework of just health care. Daniels’ principles are
matched with African principles to create a Just Health Theory, which is adapted to
the Sub-Saharan Africa context. The resulting African principles are mapped onto
the health care sector and finally blended into the Harmonised Framework of Just
Health Care. By combining the insights from Daniels with African values and
approaches, it is possible that just health care will be attained in Nigeria and beyond.