An Incomplete Africanisation: Primary Healthcare and the Transformations of Lutheran Medical Missions in Madagascar

Abstract

This article chronicles aspects of the Africanisation process in Madagascar’s health education, offering new perspectives on the history of medical knowledge in Africa. Grounded in ethnographic fieldwork, including oral histories and archival research, it provides an anthropological genealogy of nurse-led education and primary healthcare in southern Madagascar. Starting in the late 19th century, American and Norwegian Lutheran missionaries, particularly nurses and deaconesses, shaped the professional practices across the Great Island. The primary focus, however, lies on the Africanising turn in health education during the 1970s and subsequent years, a pivotal period marked by explicit efforts to adapt to local contexts and transfer knowledge and leadership. This shift reflected changes in ideology influenced by global south thinkers and practitioners and occurred under the pressure of the Malagasy government following Madagascar’s 1972 socialist revolution. Central to this transformation was Katharine Quanbeck, a Lutheran nurse who introduced community-based healthcare initiatives aligned with the Malgachisation of the health system and medical education. Drawing inspiration from Paulo Freire’s Pedagogy of the Oppressed and the Comprehensive Rural Health Project in Jamkhed, India, Quanbeck spearheaded the Mobile Health Clinics programme, emphasising adult education, hygiene and nutrition. This initiative flourished through collaborations with Malagasy Lutheran women, who played a vital role in its success and innovation. A key element of this transformation was a holistic approach to care, integrating spiritual dimensions and embracing the Fifohazana, a revivalist branch of the Malagasy Lutheran Church. The article concludes by examining the enduring legacies of these changes for contemporary nursing pedagogy and healthcare practices in Madagascar while foregrounding the incomplete and contested nature of the Africanisation. Woven throughout is an analysis of the gendered dimensions of colonisation and missionisation; completing decolonisation and Africanisation demands the transformation of women’s roles within the Lutheran Church and its healthcare system.

The authors' abstract, as published at the source. Journal of Southern African Studies, 2026 · DOI ↗