The Failure Of Donors To Account For Geography, Local Practices And Need When Creating A Kenyan Health Clinic – Stacy Coronis
In the southern part of
Of all places to build a beautiful, well-stocked and relatively high tech health clinic, the area around
The small population around Amboseli seems even smaller due to the vast distances between the bomas (villages). The bomas are spaced very far apart from each other as well as from the health clinic. Many bomas are over an hour’s walk from the nearest one and the walk to the health clinic can take half a day or more for many people. Data suggests that there is an inverse relationship between the distance to health care and the use of health care (1). This relationship is in full effect outside Amboseli because the distance to the clinic makes it prohibitive for the local population to use its services. As a result, the staff has resorted to providing mobile clinics for the area, but the mobile clinics offer limited services and are not always available to the local population.The Clash of Local Practices and Western Medicine
Another major reason this health clinic is failing is the clash between the local Maasai health practices and the Western medicine practiced at the clinic. Traditionally, the Maasai use local medicine men and plants to treat ailments (2). A medicine man lives within a community and the local people know this man their whole lives, so they often feel safer seeking treatment from him than from a stranger. The medicine man uses treatments made from local products that the Maasai are familiar with and feel at ease using (2). Many Maasai are far more comfortable with this approach than Western practices because they have grown up with these traditional approaches. The Maasai also prefer the Medicine Man’s methods because they are proven methods that the community has been using for generations. Much of Western medicine, however, is an unknown commodity for many of the Maasai. Payment options are another benefit of visiting the medicine man as opposed to traveling to a dispensary, health clinic or hospital. A medicine man is free to accept non-monetary payments, such as chickens and vegetables. He can also let a client defer until he or she can comfortably pay him for his services (2). As a result, most of the drugs available at this health clinic near Amboseli are going to remain unused because the local Maasai population goes to their medicine man either by choice or because they cannot afford to pay health clinic fees.
The Medicine Man is not the only health care provider in the Maasai culture. Maasai women overwhelmingly use local midwives and female family members to assist in at-home birth due to cultural practices, monetary considerations and geography. Even though the clinic near Amboseli has a well-equipped birthing room as well as incubators, women still choose to give birth at home. In a summer 2007 baseline health survey of Loitokitok District rural areas, which includes
It is not just the maternity ward that sits unused; the pharmacy at the clinic also remains virtually untouched. It is well-stocked, but too expensive and not set up in a way that the Maasai find easy and comfortable to use. The expense of Western medicine, particularly prescriptions, can be too great for many Maasai to handle. In Maasai culture, a man’s wealth is his cattle and children, not paper notes, so even if a man is considered traditionally wealthy he may not be able to pay for medical services at the district hospital or the local clinic (2). Even when charges are nominal, as at the
In addition to the burden of paying for medical services and prescriptions, instructions that can accompany Western medicine can be a problem because many of the Maasai, especially the women, are illiterate as they stay home to help the family instead of attending school. Most aspects of the pharmacy do not take into consideration the needs and culture of the local population.A Non-Existent Needs Assessment Leads To An Unused Facility
The geography of Amboseli and the uneasy relationship between traditional Maasai health practices and Western medicine are major. The real issue, though, is that it does not appear the donors performed an accurate needs assessment before building the clinic. The best approach to setting up a new clinic would have been to go to many areas in
As the clinic stands, nearly every aspect of it is excessive, especially the operating theater. The theater has not been used once since it was added nine years ago because no one thought to install a generator to power the lights and equipment. Even with a generator, however, there just isn’t a large enough population in the area to warrant this large complex. Despite the vivid example of waste the operating theater sets, a new wing was recently added to the clinic, but has never opened its doors.
The clinic also houses a maternity ward and incubators (but, again, no electricity to run them), but no willing or able population to use them. On the other hand,
Another problem with the clinic is that the Kenyan government has very distinct guidelines about the differences between a dispensary, a clinic and a hospital. To open their new wing, the health clinic would have to be reclassified as a hospital, meaning government officials would have to come to the clinic and declare it necessary that a hospital be in the area. If an accurate needs assessment had been completed before construction began, donors would have known that the new ward would push the clinic into hospital territory. The reclassification of the clinic as a hospital is unlikely to happen for many reasons, not the least of which is that the area outside of Amboseli does not need a hospital because it does not have the population to support it.
It does not appear that a needs assessment of the local population or the staff has been done since the clinic was constructed either, considering the new, unopened wing. If the donors were to conduct regular assessments, then they might realize that the staff at the clinic only needs to work part-time or that the staff’s time would be better spent at mobile clinics instead of idling the day way inside the clinic. Even if the donors will never conduct a needs assessment themselves, the clinic staff should do it themselves and report their findings. If the staff did this, they could have some input on how the money could be best spent instead of watching it get wasted on unnecessary construction and technology. The total lack of interest in figuring out what the local population needs and wants leaves this health clinic empty and useless.Conclusion
It is heartbreaking to see so much effort go into creating a health clinic that few people use simply because donors failed to consider the geography and population of the area, the Maasai’s reluctance to use Western medicine for many ailments and the necessity of the clinic to exist at all. With even a cursory needs assessment, donors could have come up with a better solution to local health needs. Instead, one gets the answer to the question, “What does a failed public health intervention look like?”
1. Peters, David H., Anu Garg, Gerry Bloom, Damian G. Walker, William R. Brieger, M. Hafizur Rahman. “Poverty and Access to Health Care in Developing Countries.” Annals of the
2. Timayio, Senewa Maasai Culture and Practices lecture. SFS
3. SFS/NIDRA Baseline Health Survey.
4. Gibson, A., S. Asthana, P. Brigham, G. Moon, J. Dicker. Geographies of need and the new NHS: methodological issues in the definition and measurement of the health needs of local populations. Health & Place Volume 8. Issue 1, March 2002; 47-60.