Struggling with Population Heterogeneity in African Cities: The Urban Health and Equity Puzzle

Gabriel Pictet, Université de Ouagadougou
Robert Pond, Université de Ouagadougou

African cities are growing fast and yet their health systems remain totally inadequate. Part of the urban health problem results from the very characteristics of African cities: cultural heterogeneity, loose and volatile social organization, abundant, expensive and unregulated healthcare, undermined by unaccountable, incompetent and abusive health workers. As a result, malaria continues to be the leading cause of infant and child mortality despite the availability of inexpensive and effective antimalarials. This paper analyses the challenges of urban health in SSA using the example of childhood malaria in Ouagadougou, the fast growing capital of Burkina Faso. It then evaluates an alternative health strategy designed specifically for the urban setting and discusses the feasibility, effectiveness and equity of population-based distribution of antimalarials in the light of the intrinsic characteristics of African cities.