Dividends of disquiet popular politics and economic thought in the history of government medical services in Nyasaland/Malawi, 1914-1983

Luke Messac, University of Pennsylvania


This dissertation is a history of medicine in development planning and popular politics in Malawi between the First World War and 1980. Using archival sources and oral histories, this dissertation seeks to explain when and why access to biomedical care became a central political concern and budgetary priority. During both the colonial and early post-colonial eras, Malawi's governments increased spending on biomedical care to demonstrate beneficence, particularly when they faced popular reactions to widely hated policies. Government officials and international advisers persistently attributed Malawi's inadequate medical provision to the nation's poverty, but changes in health spending have not automatically followed shifts in GDP or government revenues. Instead, the construction of new hospitals and dispensaries, the purchase of new supplies and medicines, and the addition of medical staff have almost always come in the wake of social unrest (in particular, following world wars and internal protests). Only at these moments was the government compelled to devote more resources to health. Yet unrest did not automatically lead to increases in Medical Department spending. Increases in health expenditure often came only after influential officials argued that there was a link between medical spending and regime stability. The first attempts to bring “Western” medicine to Nyasaland’s African population came after the great disruptions caused by the First World War. The most rapid increase in public sector health spending came during the Federation era, when popular protests threatened the government. This rise in spending occurred even though influential modernization theorists counseled governments like Nyasaland’s to avoid spending on health care. In the months after independence in 1964, President HK Banda abandoned health fees during a moment of political crisis. In the years that followed, he turned his attention away from medicine as his hold on power solidified. Each of these episodes demonstrates that official claims that there was simply not enough money to improve health services have almost always been abandoned during periods of political crisis. Still, these moments have been infrequent; placidity, and not just poverty, helps account for Malawi's dismal medical infrastructure.

Subject Area

African Studies|African history|History

Recommended Citation

Messac, Luke, "Dividends of disquiet popular politics and economic thought in the history of government medical services in Nyasaland/Malawi, 1914-1983" (2016). Dissertations available from ProQuest. AAI10194862.