Institute for Development Studies, University of Nairobi

Primary Health Care (PHC) programmes attempt to put the responsibility for the design and implementation of rural development projects in the hands of local people. PHC programmes have been developed in acknowledgement of the failure of past top-down programme design. This paper describes two examples of PHC programmes intended for implementation in Mbita Division, south Nyanza; Community Based Health Care (CBHC), and income generating projects for women's groups. I argue that such programmes need to incorporate an understanding of the local sociological, ecological, and infrastructural constraints in the programme design. Implementing Community Based Health Care (CBHC) will necessitate enlisting active community discussion and participation at the outset, and ideally the local communities should bear some of the financial responsibility as well. Incorporating the traditional medical practitioners whose services are still valued will increase the efficacy of the programme. Attempts to support income generation projects for women's groups must acknowledge the lack of cooperation between women, which is fostered by changes in marriage patterns which break down kin ties between women. The absence of business management skills, low educational levels, and conflicting labour demands on women represent additional serious constraints to the success of income generating ventures. To address these local constraints programme should allow for more individualized participation rather than requiring cooperative ventures, and financial support would be better spent for conducting management training and study tours for women rather than allotments for project seed money.