Just Health Care in Nigeria – The Foundations for an African Ethical Framework

Abstract

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.