Cooperation and competition

Abstract

Histories of colonial medicine in sub-Saharan Africa have tended to focus on the role of the colonial state in establishing and running health systems. Where voluntary agency roles have been considered, it has presented them as operating outside that system, independent and isolated. This chapter explores how voluntary (mission) sector health service providers interacted with the colonial state in creating a health system in Tanganyika characterised by its public-private hybridity. Mission health providers were formally made part of the country's health system, a process that led to the creation of a distinct ‘voluntary sector’ which continued to shape non-state action in social development and welfare after independence. The colonial state relied upon voluntary sector engagement to meet (however partially) its obligations in health care provision; and the missions saw their incorporation into the official health system as an opportunity to exercise greater power in helping to shape health policy and direction, as well as a means to ensure their primacy as non-state voluntary actors.