The Catholic Church provides the bulk of Africa's healthcare

The Catholic Church is the largest non-governmental provider of healthcare in Africa. In several countries, it is the largest healthcare provider, period. And that’s without saying anything about the healthcare systems that were established by Catholic missionaries but later co-opted, or nationalised, by governments.

In much of Africa, as in most of Europe, healthcare is widely considered to be a public good. It's supposed to be free or low-cost, and the government is supposed to be the primary provider of services. For this reason, governments tend to be the main focus of international attention with regard to healthcare in Africa.

In reality, however, most African governments are pathetic healthcare providers. The facilities they run are, as a rule, so dilapidated, understaffed, dysfunctional, under-resourced, and unevenly distributed, that most Africans only consider getting treatment from them as a last resort.

What is more common is that non-governmental facilities provide a significant portion of the continent’s primary healthcare services. Of such facilities, there are two broad types. Since they are businesses, the strictly private kind tend to serve only the better-heeled members of society, and so exclude the vast majority.

It is from the other kind, the primarily non-profit facilities, most of which are faith-based, that the mass of African patients receive care. In a sense, it is these faith-based health systems that most accurately fit the public good model of healthcare in Africa. Not only do they fill the large gaps left by the private sector, but they are also decidedly more reliable than the ostensibly public government-run systems.

Mission field

Like most modern structures in Africa, faith-based healthcare has its origins in the colonial era, when missionaries established health facilities, usually alongside schools, to serve natives. In a few cases, it was a tool for entrenching colonial rule. Most often, it filled a gap left by colonial governments, which were rather lethargic about seeing to the health and education of the locals.

By independence, most of the continent’s healthcare was provided by facilities established by Christian missionaries. Many independent African governments, keen to cement their control of their countries’ healthcare systems, nationalised many of these facilities (again, often alongside the schools); this is how most government-run health systems in Africa got their start.

Naturally, the degree to which this was done differed across the continent. In some countries, like South Africa, most faith-based facilities got nationalised and integrated into government-run systems. In others, like the Democratic Republic of the Congo and Kenya, faith-based providers were mostly left alone, or unsuccessfully nationalised, and now account for more than half of the health system.


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Most countries are somewhere in between. They tried to nationalise faith-based facilities, but either failed to do so or, having nationalised them, subsequently ran them to the ground, so that they were handed back to their original operators, or the resulting slack was picked by new facilities established by the dispossessed missionaries.

The result is that, even today, faith-based facilities are the main source of healthcare services in many parts of the continent. And given that the Catholic church is by far the most significant player in the faith-based healthcare sector, it may very well be said that the Catholic church is the backbone of the continent’s healthcare system. Like all bold claims, this one requires bold evidence (which I hope I have already given), but it is hardly controversial.

Sexual ethics

If there has been any controversy, it has been about the influence of Catholic values on the manner in which Catholic facilities provide care. The first wave of controversy, at the height of the HIV/AIDS epidemic in the mid-2000s, concerned the provision of care to HIV/AIDS patients. In particular, the Catholic church’s disapproval of condom use, which meant that Catholic facilities could not dispense them, drew no small amount of ire and derision.

More recently, controversy has revolved around sexual and reproductive healthcare and rights (SRHR), which is the rather cumbersome euphemism for contraception and abortion. The Catholic church disapproves of both, and hence its health facilities cannot provide them. And since it is the primary provider in so many regions, those regions are, in effect, locked out of such services.

Given how much ink has been spilled on both issues, one would think these controversies have been more universal. On the contrary, they have been almost exclusively Western. In Africa, especially in the communities served by Catholic health facilities, there has hardly been a peep about them.

This shouldn’t be surprising, except to the most dyed-in-the-wool highly privileged Western activist. For ordinary Africans, jaded by lacklustre government service, and excluded by elitist private providers, Catholic healthcare is a blessing. It is affordable, accessible, good quality, caring and reliable. Its values are centred on human dignity, which makes it truly welcoming to all who need it.

No amount of controversy has been able to dent this reputation. And it’s unlikely any will in the foreseeable future. Western activists be damned.

Mathew Otieno is a Kenyan writer, blogger and dilettante farmer. Until 2022, he was a research communications coordinator at a university in Nairobi, Kenya. He now lives in rural western Kenya, near the shores of Lake Victoria, from where he's pursuing a career as a full-time writer while concluding his dissertation for a master's degree. His first novel is due out this year.

Image: Pexels


Showing 13 reactions

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  • mrscracker
    Mr. Fannon,
    Comments like yours are one of the reasons I read Mercator. It brought tears to my eyes. God bless your dear mother. I feel exactly the same way. The best memories are of our families & our children. Not our material possessions, wealth, or status.
  • John Fannon
    commented 2024-02-24 22:06:53 +1100
    My mother had 4 four children and I am the eldest. All our childhoods were in Liverpool in the 1940s and after war, apart from the devastation (she and my father were ‘bombed out’ three times) there was little coal available during the hard winters. Everything was rationed but that was not a hardship; we had little money anyway. My mother had wanted many children because she was an only child and missed having brothers and sisters. Later on in life when asked what was her happiest time she answered ‘when you children were small’.
  • mrscracker
    I give credit where credit is due Mr. Bunyan. But thank you again for your kind words.
  • Paul Bunyan
    commented 2024-02-23 09:20:00 +1100
    God didn’t feed, house or educate your children. Give yourself some credit.
  • mrscracker
    God is responsible for the good things I’ve been blessed with. The difficulties in life have been mostly my own making. But we learn & grow from our mistakes.
  • Paul Bunyan
    commented 2024-02-23 08:56:51 +1100
    That’s another damaging quality of religion. It encourages people not to take responsibility for their actions.

    If god is responsible for everything in your life, there’s no need to feel guilt, because there’s no free will. Everything’s part of his “grand plan.”
  • mrscracker
    I don’t think I conceded anything like that Mr. Bunyan. Every child was a true blessing & my life has been easier because of them, not harder. But thank you for the kind words about dedication. I appreciate that very much.

    I didn’t choose to have children, God sent them to us.
  • Paul Bunyan
    commented 2024-02-23 08:47:42 +1100
    Thank you for your response, Mrscracker. I’m glad you conceded that having lots of children didn’t make your life any easier. I admire your dedication.

    But why did you choose to have biological children instead of adopting children in need?
  • mrscracker
    What I’m trying to say Mr. Bunyan is that Africa’s not in a very different place than most of the West was several generations ago & I’m not sure they require our advice.
    I spent all of my time at home raising a family & while that doesn’t earn you any Social Security credits it did me no harm in finding employment when I was widowed. In fact, it helped me secure the position I have now. My employer said that anyone who could raise & homeschool 8 children, dress out a deer & can the meat could probably handle any commotion that came up in the office.
    You don’t give women as much credit for resiliency & resourcefulness as you should. And that should apply to Africans, also.
  • Paul Bunyan
    commented 2024-02-23 08:00:40 +1100
    Mrscracker, I hope you aren’t trying to minimize or ignore the harms of child marriage by saying, “That’s just what they did back then.”

    Well, child labor was very common back then, too. We’ve since learned that giving all children a decent education is far more important. That way, they can contribute to society in ways besides physical labor. This is crucial, especially if they get injured in a way that makes physical labor impossible for them.

    Why is early marriage connected to poverty? Because education is a major determinant of income. And women who spend all their time at home raising children are dependent upon their spouse and family for their income. Which is why they tend to be trapped into poverty loops.
  • mrscracker
    “What do you think is going to happen when girls are married off before they’re 15 and expected to have more than half a dozen children?”
    Well, I can only speak from my own family’s experience but I have several great grandmothers who were married at 15 or younger & I bet you do, too if you look back far enough. That was almost every family’s story.
    Large families were a common story until quite recently also. A rather distant grandma of mine was married at 12 & had 9 children by the time she was widowed at 31. One of her greatgrandchildren won the Pulitzer Prize & became a poet laureate. All of her children & grandchildren that I’m aware of were successful , contributing members of society.
    If you are saying that a connection between poverty & beginning marriage early/ larger families is something unique to Africa, that’s a different proposition. I rather doubt it, but I know for my own family of eight children & my family’s history that’s not been the case.
  • Paul Bunyan
    commented 2024-02-22 11:12:52 +1100
    The high birth rate in Africa is directly responsible for high levels of poverty, which is a major reason why healthcare is so atrocious.

    It’s the primary reason why education and literacy rates are so poor. What do you think is going to happen when girls are married off before they’re 15 and expected to have more than half a dozen children?
  • Mathew Otieno
    published this page in The Latest 2024-02-22 09:08:55 +1100