Patient-Centered Care and People-Centered Health Systems in Sub-Saharan Africa: Why So Little of Something So Badly Needed?

Main Article Content

Jeroen De Man
Roy William Mayega
Nandini Sarkar
Evelyn Waweru
Mart Leys
Josefien Van Olmen
Bart Criel


Patient–centered care (PCC) is increasingly recognized as a key dimension of quality healthcare, but unfortunately remains poorly implemented in practice. This paper explores the current state of PCC in sub-Saharan Africa and potential barriers to its implementation, with a focus on public first line health services. We develop an analytical framework based on expert knowledge, field experience, and a conceptual literature review. Factors contributing to the (lack of) implementation of PCC are structured in three distinct but interacting layers. The first layer encompasses factors that influence and shape the performance of providers.  The training of health workers is key in that respect. Training models remain dominated by a biomedical perspective, with little attention for psychosocial dimensions of the illness experience. The second layer of determinants relates to the structural and organizational features of the health system. The emphasis in many African health care systems on specific programmatic outputs, and the subsequent pressure this creates on health workers,  jeopardize the delivery of PCC. The third layer is related to the broader socioeconomic environment in which health workers operate. Noteworthy is the gap between the “official” norms in the public sector and the actual behavior of providers. We then propose  possible avenues for change for each of these three layers. We conclude by arguing the need for further fine-tuning of the framework outlined in this paper, investing in the contextual validation of measurement tools for PCC, and testing solutions in a participatory action research framework.

Article Details

Regular Articles
Author Biographies

Jeroen De Man, Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium

Unit of equity & healthCorresponding authorPhone: +32 489 392 394

Roy William Mayega, Makerere University School of Public Health Mulago Hill Kampala, P.O. Box 7072, Kampala, Uganda

Department of Epidemiology and Biostatistics 

Nandini Sarkar, Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium

Unit of equity & health

Evelyn Waweru, Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium

Unit of equity & health

Mart Leys, World Health Organisation headquarters, Geneva, Switzerland

Service Delivery and Safety Department

Josefien Van Olmen, Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium

Unit of health service organisation

Bart Criel, Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium

Unit of equity & health


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