Social determinants of health and institutional complementarities in Africa: a challenge for health policies

Abstract

This article investigates the shortcomings in the implementation of an approachbased on the social determinants of health in sub-Saharan Africa. This approach is extendedby looking at health and development from a political economy perspective. This perspectiveacknowledges the non-linear nature of the political decision-making process and the absenceof any institutional ideal type. The notion of institutional complementarities is used toinvestigate the deficiencies in this area in sub-Saharan Africa. It will be shown that the healthprogrammes are based on a rationalist postulate and vertical concept of the problems and arecharacterised by low levels of institutional complementarity. The article’s contribution to theliterature rests on its use of an expanded political economy perspective to help bridge the gapbetween public health and analyses of public policy.