This thesis examines healthcare provision in the Central African Federation, the late colonial union between the British colonies of Southern Rhodesia, Northern Rhodesia, and Nyasaland (the later independent nations of Zimbabwe, Zambia, and Malawi respectively). Unusually in federal formations, healthcare delivery in the Federation of Rhodesia and Nyasaland became a federal function. "Settler Visions of Health" seeks to explain how the white settler elite reconciled the language of development and multiracial partnership with the underlying values of a settler society. Throughout its short existence, the Federal Health Service maintained a celebratory narrative of success designed to legitimize and justify both the decision to federate health and the Federation’s existence. The takeover of health allowed the federal government to project an image of the Federation as a rapidly developing, progressive nation that had brought significant benefits to the standard of living of African people. The reality was more checkered. The Federal Health Service struggled to live up to its promise of benevolent biopower. It largely perpetuated a colonial legacy that neglected to establish solid foundations of health consisting of sufficient infrastructure, adequate training, and equitable healthcare policies. I argue that the decision to federate health is best understood within a context of settler nation building and that paying attention to the rhetoric and realities of healthcare provision in the Federation illustrates how progressive ideas about access to healthcare and medical careers for African people could serve to maintain a settler colonial order. In addition to maintaining earlier colonial inequities of healthcare provision, federal healthcare policies and practices tended to marginalize health delivery in the northern territories contributing to the fragile health systems that Zambia and Malawi inherited when they attained independence.