Health Care, Welfare and Development in Rural Africa: The Case of the Catholic Health Services in Ifakara/Tanzania in the 20th Century

This thesis argues that not only have health services changed throughout the 20th century. But these changes have been intricately linked to the political (and with it the cultural and discursive) re-configurations of social rights and entitlements to various elements of health care. The thesis looks at changing regimes of solidarity through an analysis of changing forms of health care and health governance in a rural area of Tanzania.
The project uses a specific angle to look at these developments: it is based on the experiences linked to the health services offered by the Catholic Church in the inland parts of the Diocese of Dar es Salaam and (later) Mahenge in Tanzania (approx. what today are the Kilombero and Ulanga districts). After WWI Swiss Catholic missionaries (re-)opened a range of mission stations, leper asylums and dispensaries. Social and medical services administered through the mission organisation developed especially from the late 1930s. In contrast to most other missionary centres, Ifakara was at a low altitude and considered as infested with disease. But it was unquestionably a centre of the local economy and soon developed into a major site for maternal health care provided by the missionaries. In the late colonial period these services grew into the largest hospital and medical training and research complex in the wider area (the St. Francis Designated District Hospital). This would have been impossible had not local, regional and international interests crossed at Ifakara. Especially with the opening of the new hospital in the late 1950s, Ifakara became a place of considerable interaction of diverse actors in the health system. The history of the hospital and its people, and the diverse range of health interventions that centred on this institutional node constitute the empirical base for the main arguments of the thesis which speaks about the history of transnational solidarity, and of the expectations and limitations in development practices.