Active patients in rural African health care: implications for research and policy

Health Policy Plan. 2014 Jan;29(1):85-95. doi: 10.1093/heapol/czs137. Epub 2013 Jan 9.


We introduce the 'active patient' model, which we claim is a better way to describe health-seeking behaviour in low-income countries. Active patients do not automatically seek health care at the closest or lowest cost provider, but rather seek high-quality care (even at higher cost) when they estimate that such care will significantly improves outcomes. We show how the active patient can improve his or her health even when access to adequate quality care is insufficient and that the empirical literature supports this model, particularly in Africa. Finally, we demonstrate the importance, in analysing health care policy, of recognizing patients' efforts to improve health outcomes by seeking quality care.

Keywords: Africa; Agency in health care; asymmetric information; rational peasant; rural health care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa / epidemiology
  • Health Policy*
  • Health Services Accessibility / statistics & numerical data
  • Health Services Research* / methods
  • Humans
  • Outcome and Process Assessment, Health Care
  • Patient Acceptance of Health Care / statistics & numerical data
  • Quality of Health Care
  • Rural Health Services / statistics & numerical data*
  • Rural Population / statistics & numerical data