The publics of public health in Africa

How do we understand the public character of public health in contemporary Africa? What are the parameters of community engagement in health care delivery, medical research and disease control programmes? To what extent is public health in Africa a project led by African Governments? Through what political processes and deliberative practices can African publics influence the priorities of research in health sciences and interventions which aim in broad terms to improve the health of such publics? Drawing insight from empirical research conducted with African scientists, nurses, community members, clinical trialists and policy-makers, this special section examines the multiple ways in which the public comes into being around public health provisioning and investigation in sub-Saharan Africa, its role and political reach. Collectively, these papers show how contestation and negotiation around different ideas about who the public is and what being public means can lead to the emergence of conflicting understandings, with implications for who and what is seen to represent the public interest, and for the acceptance of research and other interventions. The democratic potential of public participation has been a concern of development economics, moral philosophy, media studies and political science for quite some time. More recently, the task of enrolling the public in decision-making processes has become a salient issue for scientific and technological expertise: contemporary science policy emphasises the integration of public views into the assessment of research aims and outcomes (e.g. Jasanoff, 2010; Stilgoe, Lock, & Wilsdon, 2014). However, whose views should be included, how they are to be taken into account and to what end, are questions that perennially generate policy debate. In recent years, social scientists have begun to investigate interactions between science and society beyond and between specific European and African locations (Craddock, Giles-Vernick, & Gunn, 2010; Montgomery, 2012). Seeking to ground political concepts such as ‘citizenship’, ‘public good’ and ‘representation’ in their diverse geographies and histories, scholars have pointed to the social solidarities that form around health issues and interventions (e.g. Kelly & Lezaun, 2014; Leach, Scoones, & Wynne, 2005; MacGregor, 2009). While on the one hand, these emergent publics seem to promise a new model for the relationship between government, science and citizen that cross cuts the localglobal divide (Robins & Lieres, 2004), the tendency of foreign donors, global health professionals and activist organisations to regard emergent communities as the locus of democracy potentially undercuts national sovereignty and suggests unsettling parallels with both colonial rule and post-independence autocracy (e.g. Kamat, 2004; Lachenal, 2011; Nguyen, 2010). Furthermore, community-based organisations and NGOs, which proliferated in African settings in response to increases in global assistance for health, have marketed themselves as close to ‘local’ interests and giving voice to these, reinforced by donor constructions of the ‘community’ as an appropriate target for vertical interventions (Edstrom & MacGregor, 2010). Some argue that the central role of NGOs in efforts to democratise African civil society points less to the empowerment of the grassroots than the triumph of a neoliberal model of governance (Dill, 2009; Kamat, 2004). For many African governments forced to restructure health activities in tune with the priorities of the World Bank, a public health system has only ever been a notional concept, or one greatly compromised by multiple social, material and political constraints. The effects of structural