My first book, No More to Spend, was published by Oxford University Press in 2020.

Named a CHOICE Outstanding Academic Title.

“No More to Spend is a beautifully rendered social history, but it is also a superb and humane ethnography. Like a good historian, Messac advances while looking backwards. Like a good anthropologist and a superb doctor, he casts his eyes, and his thoughts, on people like Francis, trudging forwards against long odds not of his own making.”

— Paul Farmer, Harvard University and Partners In Health

“In global health, there are still too many excuses for inaction…Messac’s book exposes the origins of arguments – ones I have heard far too often – for why we must value some human lives more than others.”

— Agnes Binagwaho, University of Global Health Equity, Rwanda

“Should be compulsory reading for all those interested in global and public health in the Global South…Messac’s work is a brave and important book, one that asks, with cold clarity and detailed historiographic work, the ‘politically uncomfortable questions of distribution’ that many only touch on.”

— Social History of Medicine

Are patients in poor countries really doomed to go without modern medicine? In many countries, officials speak of health care as a luxury, and convincing politicians to fund quality health services is a constant struggle. Yet, in many of the poorest nations, health care has long received a tiny share of government spending. Colonial and postcolonial governments used political, rhetorical, and even military campaigns to rebuff demands by patients and health professionals for improved medical provision.

No More to Spend challenges the inevitability of inadequate social services in twentieth-century Africa, focusing on the political history of Malawi. Using the stories of doctors, patients, and political leaders, No More to Spend demonstrates how both colonial and postcolonial administrations used claims of scarcity to justify the poor state of health care. Calls for better medical care compelled governments, like that of Malawi, to either increase public health spending or offer reasons for their inaction. The recurring tactics for prolonged neglect have important implications for global health today. 

Read a roundtable discussion on the book on H-Diplo.