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Social Science and Medicine. 1990; 31(6):639-48.Sub-Sahara Africa (SSA) has gone from "classical colonialism to neocolonial debt bondage." this article traces SSA's deterioration from a master-servant relationship during colonialism to the present-day "hybrid of decay and anarchy" from which people's health status and health services in the region are being asphyxiated by the debt crisis. The tragedy facing the continent is a carryover from colonialism SSA remains dependent on outside multinational forces that continue to determine her policies, extract her natural wealth, and minimally invest in the SSA region. This continued "cola-colonization" or external control of SSA has resulted in the "catastrophic" decline of most of SSA's social and economic institutions reflecting the collapse in the economies of the West. By the end of 1986, SSA owed US $200 billion or 45% of its GDP--growing to over US$600 million by the year 2000. By 1990 all SSA countries had to accept structural adjustment policies (SAP's) imposed by the International Monetary Fund and the World Bank to monitor cuts in Government public spending, remove subsidies, trade liberalization and currency devaluation all leading to "tragic declines" in the standard of living. Health services in SSA also originated from colonialism and today remains dependent on the home government's. One of the major carry-over's is the urban/rural disparity; 70% of SSA's population is rural yet most health services and providers are in the urban areas contributing to higher infant mortality rates (2-5 times) in the rural areas. The debt crisis has compounded the magnitude of the lack of health services for the majority of people. Shortages exist for all essential drugs and equipment while social services and institutions have deteriorated, aggravating the already low health status in the region. SAP's have increased starvation, epidemics and the brain drain. Perhaps there is a need for a "Marshall Plan" to help SSA out of its underdevelopment.