A history of health sevices in Nairobi C.1899 - 1963
Odinga, Agnes Adhiambo
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The study traces the development of health services in Nairobi from 1899 to 1963. In this broad historical survey and analysis, the study specifically establishes the origin of the qualitative and the quantitative inadequacy of health services that characterised colonial Nairobi and has persisted in independent Kenya. To understand the genesis of the problems, the study analyses the colonial rule. A background chapter examines the economic and political history of Nairobi. This is in view of the fact that the socio-economic system under which people live, produce and reproduce, determines their health and well being more than does the natural environment. On the basis of this assumption , it is argued that the socio-economic changes that accompanied the colonial governmental settlement in Nairobi created favorable environmental conditions for the propagation and spread and spread of different disease earlier unknown in Nairobi. the political machinery on the other hand, patterned the production and the distribution of health status of the population and also not at stimulating equitable distribution of the health resources, but geared towards optimization of profit. Before 1914 for example, the colonial government health services were limited to the colonial officials, the railway employees and only those Africans who were in government employment. Health services were only extended to the Africans and Asians outside the colonial government employment as emergency measures to check on the spread of epidemics from the African zones to the European zones. Emphasis was put on curative as opposed to preventive medicine; on protecting the health of the male as opposed to the female. As a result of the changes that emanated during World War 1, the colonial government realized the necessity of extending the health services to the population that earlier had no access to the services. After the War as a matter of policy therefore, the colonial government revised its health care provision policy. The post-World War I health policy emphasized the provision of health services to everybody and both te preventive and curative medicine were given due recognition. This led to the rise of the dispensaries, child welfare centres and the creation of the sanitation division in medical department. It is, however, argued that, though this was a positive move, the population hitherto denied the services had become unmanageable in light of the available health resources. It is also shown that the move to extend the services to the population had economic motives and therefore not aimed at improving the health status of the population in Nairobi. Due to the imbalance in the provision and distribution of the health services, the intensified Africans and Asians demand for equitable distribution of the services, and the changing global distribution of the services, and the changing global outlook towards the health of the population in general; in the post-World War II era, the colonial government devised new health policies. This led to the rise of the ''health centre’’ system, and for the first time Africans were required to pay a fee for the health resources at their disposal. This further deteriorated the health of the population. Thus, instead of serving the intended purpose, the services were used as a political weapon to increase the Africans dependence for exploitation. The study also discusses the colonial government's response to the manpower requirements. It is shown that before 1914, apart from the missionary endeavors in the rural areas, the colonial government was reluctant to train Africans. It was after World War I and in response to the Post-World War I health policy, that the need to train Africans was deemed essential. However, when the colonial government did move to train Africans, it was at very subordinate levels to ensure the European monopoly of the health service market and also to justify the exploitation of the Africans in the medical profession. The study finally looks at the evolution of the colonial medical researches. It is ostensibly argued that the researches were initiated to improve the health conditions, whereas in actual sense they were meant to check on the diseases that threatened the productivity of the labour force.