From Missionaries to Entrepreneurs in the Business of Hospitals in Africa

The introduction of modern hospitals to the people of Africa followed state formation and the political economy of social security provision. Church missions introduced the first hospitals. Modern hospitals gradually replaced some faith-based hospital establishments to supplement state hospitals. Rising medical costs, demand for sophisticated procedures and application of top-end medical technology opened the door to a parallel system of private health care in societies able to afford it. To deliver advanced medical procedures and access to advanced pharmaceutical products the case arose for better business models for health provision, funded increasingly by private medical aid models. This chapter addresses this development in Africa, with specific reference to health policy, state capacity and the liberal market for specialist medical services in South Africa.