Abstract
BackgroundLack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political support, and on alignment of international and national actors. We explore if the analytical framework of social exclusion can contribute to the latter.MethodsWe produce a critical and evaluative account of the literature on three themes: social exclusion, development policy, and indigence in Africa–and their interface. First, we trace the concept of social exclusion as it evolved over time and space in policy circles. We then discuss the relevance of a social exclusion perspective in developing countries. Finally, we apply this perspective to Africa, its indigents, and their lack of access to health care.ResultsThe concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international policy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents.ConclusionThe concept of social exclusion provides a useful framework for improved understanding of origins and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
Highlights
Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote
At least in international circles, equity became a concern and by the end of the century, Stierle and colleagues provided a comprehensive review of concepts and policy measures related to indigents in sub-Saharan Africa [6].b First of all, the authors observed a widespread lack of precision on how to define indigence
Eventually–spelling out indigence as “the advanced state of poverty and social exclusion” and taking stock of the limited success of a segregated technical approach that had been unable to break the circle of poverty and to counteract social exclusion–Stierle and colleagues made a case for the integration of the technical and the political approaches [6]
Summary
Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. At least in international circles, equity became a concern and by the end of the century, Stierle and colleagues provided a comprehensive review of concepts and policy measures related to indigents in sub-Saharan Africa [6].b First of all, the authors observed a widespread lack of precision on how to define indigence. They noted that the complex concept of indigence “covers, at least and interdependently, the dimensions of poverty and social exclusion” and that “the distinction between poverty and indigence seems important for countries where the majority of people are poor”. Eventually–spelling out indigence as “the advanced state of poverty and social exclusion” and taking stock of the limited success of a segregated technical approach that had been unable to break the circle of poverty and to counteract social exclusion–Stierle and colleagues made a case for the integration of the technical and the political approaches [6]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call