Population Research Discovery Seminars

The Residua of Health Programs in Sub-Saharan Africa

Speaker: Rachel Robinson, School of International Service, American University

All health programs have residua: the side-effects that ripple outwards during implementation or that are left behind after the program is finished.  These residua may then influence other health programs, either enabling or hindering them.  For example, the monitoring system put in place to combat polio in Nigeria is credited with limiting the Ebola outbreak to just 19 cases, and there are now multiple examples of how community health worker programs developed to combat HIV/AIDS are aiding the response to COVID-19. Drawing from examples of health programs implemented in sub-Saharan Africa—family planning, HIV/AIDS, polio, and Ebola—the paper uses theories of path dependence, policy feedback, and social capital to develop a framework of health program residua and draws two main conclusions.  First, when designing or revising health programs, donors and other implementing organizations should take into consideration the residua of previous health programs, which may either serve as resources or obstacles.  Second, donors and governments should invest in structural interventions that address the social determinants of health, rather than vertical programs that narrowly focus on one disease, in order to increase the odds of positive residua.