Overview of Africa’s Post-Conflict History
Historical Formal Institutions

Colonial legacies persist in Africa in spite of a post-colonial era (Austin, 2010). These legacies have continued in post-conflict Africa’s history. In Africa, there has been no real unifying factor bringing individuals together, primarily because of the communal aspect of society throughout the continent. Community exists and can be found everywhere in Africa. Structural, dramaturgic and institutional factors in formal institutionalization in Africa of health care has come about as a result of investment, development, and political stability (Ratcliffe, 2013). The relationship among cultural traditions, laws of society, and the symbolic boundaries have served to create the structural meanings behind formal institutions; the expressive dimension, communicative properties and interaction of these elements have made up the dramaturgic, and the actors and organizations themselves have manifested the institutional. An example of this can be seen in Nigeria.

Structurally, dramaturgically and institutionally, Africa has undoubtedly been impacted by the West over the past few centuries. It has not been untouched by the modern era, and in nations like South Africa one can see just how much the West has influenced African society (Bratton & Van de Walle, 1997). Yet other parts of Africa, like Eritrea, in spite of the system of government, is of a higher quality for the people there than it is for the people of South Africa in their nation (Morrison & Stevenson, 1972; Ratcliffe, 2013). This may be because of a closer reliance to native dramaturgical and structural meanings. To make such an argument, however, one must define what is meant by these meanings (Southall, 2003). To do that one must examine the lives of the people in question to see what they themselves value and how well they succeed at attaining those values rather than applying external values shaped and fashioned by hundreds of years of experience in some other continent and imagining that they will have any significance for the people in question (Southall, 2003). To have a sense of the rules of the community, one must have a sense of the people (Afro-centric Alliance, 2001). There is a community basis for development that goes entirely missed by the progressive reformers who seek to update Africa in accordance with Westernized models of development.

As such, Africa has its mythological leaders and figures, as Prempeh (2007) points out, noting that “the assault on constitutionalism was spearheaded by Africa's larger-than-life founding fathers, leaders like Osagyefo (Victorious Warrior) Kwame Nkrumah (Ghana), Mwalimu (The Teacher) Julius Nyerere (Tanzania), le Grand Silly (Elephant) Sékou Touré (Guinea), Ngwazi (Great Lion) Kamuzu Banda (Malawi), and Mzee (Esteemed Elder) Jomo Kenyatta (Kenya)” (p. 472). These leaders’ mythologies were established, moreover, by nationalist movements—not necessarily by a yearning growing out of customary and traditional groups, who believed their traditional way of life could be facilitated by such figures’ success in the political realm. Rather, their stories were promulgated and exalted by other members of the burgeoning political class—the African activists and politicians emerging to fill a void in leadership at the governmental level as the era of colonization crashed into rubble. Prempeh (2007) argues that “Nationalist mythology and historiography had invested these leaders with messianic attributes for their role in wrestling sovereign statehood from the jaws of European colonialism” (p. 472). The result is an Africa whose post-colonial and post-conflict narrative has been written by individuals who have succeeded in rising to the top: the narrative is a type of political propaganda.

Nigeria is one nation in Africa that has benefited extensively from investment and development, and that has thus seen its structural, dramaturgical and institutional formal health care approach change and reflect modern universal trends (Shuaib et al., 2014). It has also demonstrated a formal ability to stop the spread of pandemics—as recently as the Ebola pandemic of 2014. Ebola first appeared in Nigeria following the 2014 outbreak that began in West Africa and spread throughout the neighboring state of Guinea. From Guinea, Ebola spread to Liberia and when a traveler from Liberia commuted into Lagos Airport, the pandemic reached the state of Nigeria. The patient was immediately identified as sick and death was recorded within five days of arrival. This case of Ebola was quickly marked as patient zero by Nigerian authorities. He was the “index patient” and through contact tracing Nigerian health authorities were able to show that he had “potentially exposed 72 persons at the airport and the hospital” (Shuaib et al., 2014, p. 867). The pandemic was swiftly monitored and contained primarily because of close monitoring and action by the Federal Ministry of Health, which was overseen by the Nigeria Centre for Disease Control, a formal institution that has been modeled on the American CDC. An Ebola emergency was declared in Nigeria immediately and no time was lost in politicizing the matter or wondering what to do. A protocol had been established by health authorities and was followed. 19 lab-confirmed cases confirmed that the virus was spreading from patient zero and 1000 contacts were identified by authorities. Before long the situation was under control and there was no sign that the outbreak would cripple the country (Shuaib et al., 2014).

Because Nigeria had experience dealing with outbreaks in the past, its national public institution was ready to respond to the Ebola outbreak: “six response teams were developed within the Emergency Operations Center (EOC). The EOC specific to an Ebola response, including: 1) Epidemiology Surveillance, 2) Case Management/Infection Control, 3) Social Mobilization, 4) Laboratory Services, 5) Point of Entry, and 6) Management/Coordination” (Shuaib et al., 2014, p. 868). This is but one example of how a formal health institution in Africa has emerged to battle health problems. However, there are many informal health institutions in Africa that have developed as a result of economic disparities that prevent poorer and impoverished populations from seeking care at formal institutions like this one in Nigeria (Nelissen et al., 2020).

Evolution of Informal Institutions

Informal Institutions on a community level

Community participation is expected in times of pandemics, as the 2014 Ebola crisis in Nigeria showed. Community care provision is also expected and anticipated (Shuaib et al., 2014). Community cost-sharing is a different story. Cost-sharing initiatives have been implemented in the past—particularly by the World Health Organization in sub-Saharan Africa—but they have not been particularly successful and many are not longer continued practices (Burnham et al., 2004; Shaw & Griffin, 1996). The reasons for discontinuation stem from political...…to do this than to go through the trouble of seeking out care from a health care facility. Thus, pain is often either dealt with or self-treated (Gbagbo & Nkrumah, 2020). However, pain medications are available. Ghana is typical of other African states in that it spends 5% of its GDP on health care services and health care is viewed as a human right in the country. Its access to care varies from region to region in the nation, but its health care facilities are deemed as high quality by neighboring states and thus health tourism is a phenomenon there (UN, 2017). Faith healers exist in African states because of the Pentecostal and Charismatic churches there as well as because of traditions among older tribes. Thus, to a small degree, the native religious tribal practices have some form of faith healing as well. It is one reason the Charismatic churches have caught on in states like Ghana: they are not dissimilar from native customs (Ngunjiri, 2011).

In societies in places such as Eritrea, one’s extended family is a crucial part of his or her life. Many people in such societies depend on their extended family for social, security, and financial support if they lose their jobs, fall sick, in case of unforeseen circumstances, and when old. It is normally regarded as the moral obligation of the family member who has a job to provide financial support to the needy, aged, and sick members of the extended family (Ghebregiorgis & Karsten, 2006: 150). This ethos is even captured in the general language of the country’s constitution. It is no surprise to hear any African person abroad mention that he/she sends money back to Africa to support their family. Another aspect of this customary practice is respecting and caring for the elderly. The aged are held in high esteem and social status. Caring for the elderly is a natural and expected part of life and also has its roots in strong religious beliefs, securing the caregiver’s future, as when the elderly pass on, they would protect and prepare the caregiver’s place in the next life. 

Challenges

In many communities across Africa, working together and cooperation was often exalted especially in times of difficulty. It is supporting one’s family before oneself has always been regarded as the right way of doing things. This kind of support is nowadays yearned for in many societies. If this knowledge of African collectivism was to be applied to organizations and adopted as the ethos, it could lead to communities supporting each other, reduced conflicts, and nations recording higher productivity (Wasilwa, 2017). The application of African collectivism can also lead to longer-term sustainability of organizations as is the case with African families and organizations that stick together. The application of the spirit of collectivism could also lead to many states also focusing on environmental protection since it will naturally become a focus when they start working like communities and caring for the environments they operate in (Eyong, 2007). The problem is that most African societies believe in communal existence and not individual existence. Adapting this attitude is the main challenge in a time of pandemic.