BACKGROUND:
Health systems in Africa are often evaluated through capacity, financing, and service delivery metrics, yet the persistent crisis of institutional weakness suggests a deeper structural issue. Many health systems operate legally but lack legitimacy—the moral and cultural authority that makes institutions trusted by citizens. This paper introduces Politicojuridity, an Africa-born analytical framework that explores the relationship between political culture and juridical order as a determinant of institutional legitimacy. It argues that health outcomes are shaped as much by legitimacy as by resources.

METHODS:
Using a politicojuridical analytical method, this study draws from case studies in Malawi and Southern Africa. It examines the disjunction between formal health governance models derived from Western legal-rational traditions and the indigenous legitimacy structures that define authority and accountability in African societies. The analysis integrates document review, public discourse analysis, and comparative institutional mapping.

RESULTS:
Findings indicate that health systems often fail not because of inadequate policy but because of legitimacy vacuums: governance frameworks that are legally sound yet culturally alien. Citizens comply instrumentally rather than trustfully, weakening community participation and policy uptake. Politicojuridity identifies three pillars of legitimate health governance: legitimacy mapping (to expose trust gaps), juridical realignment (to harmonise law with cultural accountability), and politico-ethical leadership (to re-anchor governance in public moral consciousness).

CONCLUSIONS:
Strengthening African health systems requires more than technical reform—it demands legitimacy reform. By aligning legality with legitimacy, Politicojuridity reframes public health as a relationship of authority and trust rather than mere service delivery. Embedding governance within Africa’s politico-cultural foundations can restore citizen confidence, sustain reform, and make the pursuit of “Health Without Borders” a truly inclusive and decolonised endeavour.