Abstract
This article presents key results from a comparative qualitative Social Policy study of nine African regional economic communities’ (RECs) regional health policies. The article asks to what extent has health been incorporated into RECs’ public policy functions and actions, and what similarities and differences are evident among the RECs. Utilising a World Health Organization (WHO) framework for conceptualising health systems, the research evidence routes the article’s arguments towards the following principal conclusions. First, the health sector is a key component of the public policy functions of most of the RECs. In these RECs, innovations in health sector organisation are notable; there is considerable regulatory, organisational, resourcing and programmatic diversity among the RECs alongside under-resourcing and fragmentation within each of them. Second, there are indications of important tangible benefits of regional cooperation and coordination in health, and growing interest by international donors in regional mechanisms through which to disburse health and -related Official Development Assistance (ODA). Third, content analysis of RECs’ regional health strategies suggests fairly minimal strategic ambitions as well as significant limitations of current approaches to advancing effective and progressive health reform. The lack of emphasis on universal health care and reliance on piecemeal donor funding are out of step with approaches and recommendations increasingly emphasising health systems development, sector-wide approaches (SWAPs) and primary health care as the bedrock of health services expansion. Overall, the health component of RECs’ development priorities is consistent with an instrumentalist social policy approach. The development of a more comprehensive sustainable world-regional health policy is unlikely to come from the African Continental Free-Trade Area, which lacks requisite social and health clauses to underpin ‘positive’ forms of regional integration.
Highlights
Intra-regional economic transactions occupy the preponderant share of worldregional governance and policy, matters of social governance, policy and development are explicitly present in region-building agendas (Yeates, 2017, 2019; Yeates and Deacon, 2010)
It is telling that a recent major comparative regional study of African regional economic communities (RECs; Hout and Salih, 2019) made no reference whatsoever to the long-standing and discernable evidence of their social policy content, as charted by Deacon et al (2010) and, more recently, Van Der Vleuten (2016)
It indicates the degree of variation and selectivity as to which areas and sub-components of health policy feature in RECs’ regional health policies
Summary
Intra-regional economic transactions occupy the preponderant share of worldregional governance and policy, matters of social governance, policy and development are explicitly present in region-building agendas (Yeates, 2017, 2019; Yeates and Deacon, 2010). Closer scrutiny and evidence of RECs’ agendas, discourses and programmes are needed to begin to answer these questions Such evidence can contribute to improving the knowledge base regarding extant forms and impacts of social regionalism worldwide, and generate new insights into the wide range of forms that health governance and policy takes and the conditions under which it develops in the Global South. Actual track records and potential new dynamics flowing from regionalist multilateral actors remain under-researched This is especially the case in relation to Africa, where, despite the existence of multi-disciplinary social research efforts, there has been next to no dialogue between social policy, health studies, development studies, regional studies and African studies. A better understanding of the multi-level governance of the health sector and of the diverse spaces across which it plays out will be important in assessing the potential for RECs to be harnessed to achieve the health and -related SDGs
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