Epistemological relevances in community-based health care programmes in the republic of Kenya
Creators: name: Willms, Dennis George
Publisher: name: University of British Columbia
Year: 2010

description: This dissertation examines the problem of ‘community-based health care’ (CBHC) as it is interpreted in three separate health care domains. In relation to the idealistic model for CBHC (or 'primary health care’) propounded by WHO and UNICEF, health care organizations in the Republic of Kenya have constructed CBHC programmes that reflect the contingencies and relevances of their situation. This thesis demonstrates how these epistemological differences towards CBHC are predicated on organizational considerations in government, non-government, and independent programmes. In the Kenyan health care context, the event of CBHC has accentuated the differences between: an urban/rural allocation of health care resources, salaried/volunteer health care workers, modern/traditional influences, and complex/subsistence economic standards. The Ministry of Health (Case 1) has embarked on a national CBHC programme because of political (harambee: an emphasis on self-help development) and economic (aid-related monies) constraints. Yet bureaucratic inflexibility and entrenchment in the culture of biomedicine cause it to be indirectly opposed to the CBHC strategy; consequently, it is proving to be an ineffective instrument in the development of CBHC programmes. Community leaders in the Saradidi Rural Health Development Project (Case 2) have assumed a competitive posture in response to government neglect in the development of the health care infrastructure in their area. Through the construction of a comprehensive development programme (CBHC and income-generating projects), they have deliberately separated themselves from external interference and control, furthermore, the revitalization of traditional Luo social institutions has strengthened this effort in the Nangina Community. Health Programme (Case 3), expatriate mission-hospital communities have cooperated with external health care agencies, and most importantly, with clan-based groups who support the activities of their representative Community Health Workers (CHHs) .... The impetus for this organization of CBHC is attributed to the emergence of Christian Community Groups (CCGs). The philosophy of health care that has emerged is predicated on the spiritual ‘revival’ in the area, and is expressed in the revitalization of traditional social institutions of care. Relative to these separate social organizations, the epistemologies of CBHC that emerge are refracted in the position of the Community Health Workers (CHHs). ‘Horthwhileness,' in one word, encompasses the relative truths and concomitant health care goals that CHHs in each of these CBHC situations appreciate., These images of worthwhileness are varied, and reflect the realities of the organization in which they work; their phenomenological character is symbolized in professional (Ministry Of Health), progressive (Saradidi) , and spiritual (Sangina) metaphors. The total situation of CBHC in the Republic of Kenya encompasses these separate, yet impinging organizations of ‘community-based health care.' The difficulties that emerge between programmes is explained in terms of these differing epistemologies; these in turn are interpreted in relation to organizational relevances.