Paper short abstract:

Using a historical political economy methodology and case studies of Tanzania and Zimbabwe, this paper investigates the interaction of local industrial change, especially in health-related industries, with health system accessibility and local appropriateness, and draw policy lessons.

Paper long abstract:

The "health industries", including production of pharmaceuticals, diagnostics, other medical devices and hygiene inputs, have transformed health care across the world since 1945. Yet the social determinants of health literature largely ignores the impact of these industries' structure and location on health care access, quality and inequity. This paper uses a historical political economy methodology to investigate the proposition that the local co-evolution and interaction of health industries and health services is an important driver of local health care access and outcomes. The paper traces the evolving interactions between industrialisation/ deindustrialisation with particular reference to health industries, and the changing organisation and inequity of access to health services, in Tanzania and Zimbabwe from the colonial era to the present, using a mix of historical sources and recent fieldwork, and a historical political economy methodology. We show that periods of success in each country linked local industrialisation to expansion of primary health care. Local pharmaceutical firms have served private, NGO and public sector markets since early post-colonial periods; have been a source of emergency supply response in hard times; and have contributed to rural access. Meanwhile government leadership and investment have been key in periods when linkages improved equity as well as access. We argue that one element of decolonising health research is to re-embed it within broader ambitions for more locally led and sustainable local economic development.