The distribution of rural health facilities: a case study of Mumias and Butere Divisions, Kakamega District

Abstract

The overriding theme in this dissertation is that the present distribution of rural health facilities is imbalanced and that it does not pay sufficient attention to the tenets of the country's physical planning policy. It is argued that the major cause of this imbalance is the lack of coordination amongst the various agencies concerned with the provision of health services and the physical planning agency in Kenya. Whilst it is true that religious, community and private endeavours in the provision of rural health services go about their businesses oblivious of the need to avoid imbalances and the importance of spatial planning, it is equally true that the Ministry of Health also has failed in its efforts to provide health services equitably. The non-governmental agencies locate their services in such a manner as to suit their own needs. For instance, mission health facilities are located in accordance with the areas of influence of the denominations, irrespective of whether there already exist other non-mission facilities there or not. On the other hand harambee facilities are spontaneous and thus occur in response to perceived community needs or leadership influences and ambitions.

Same private health facilities are located on the proprietors' own pieces of land and are basically profit-oriented. The Ministry of Health (MOH) criteria have certain shortcomings. The MOH does not squarely deal with all types of health facilities. Secondly, their regulation of walking distance to a health facility is not realistic in view of the lack of motorised transport in the rural areas. Thirdly the MOH fails in that it does not use the growth and service centre strategy. It was also found out that even the mobile health clinic services of the mission hospitals also follow the pattern of influence of the missionary activities.rather than attempt to provide the service where it lacks. Finally, although there exist official referral arrangements amongst government and mission facilities, such arrangements do not exist as far as private and harambee facilities relations with government facilities are concerned. All the above major shortcomings and others detailed in the text of the dissertation are the causes of the imbalances identified. For the alleviation of the shortcomings identified, the dissertation makes a number of recommendations. In the first place, it is recommended that a review of the machinery responsible for the provision of rural health facilities is required. This should aim at coordinating all the agencies responsible i.e. the communities,

the government agencies like the DDC, the MOH and even the PPD, the missionaries and the private entrepreneurs. Secondly, the MOH criteria need to be reviewed with a view to making them more realistic especially in respect of transportation, the growth centre policy and the general designation of the RHUs, and the vital demographic factors such as density and distribution. Community involvement in the planning process is also recommended. Finally a number of specific recommendations regarding the study area in particular are also made. The dissertation hopes to make headway in the debate on rural health services as well as generate further discussion which would contribute to improvements in the scheme ,