The Socio-Cultural Challenges to the Bamako Initiative in Bondo District Implications for Community-Based Malaria Control

Abstract

The provision of basic health services to the underserved communities is the popular model for the implementation of the Bamako Initiative (B1) in Kenya. This paper examines the socio-cultural factors that influence the community's use of the locally available malaria control resources and the other primary health care services provided within the 131 program. An ethnographic study of the Bamako Initiative as implemented in the Luo cultural context in western Kenya was carried out between November 1995 and February 1996, in Bar Chando sub-location. 150 respondents were interviewed using a standard questionnaire with both closed and open-ended questions. The 150 respondents were drawn from 667 households through systematic random sampling. Key informants, an in-depth group interview, and direct observation provided qualitative data. The study revealed that very few people utilized the BI community-based services, or took part in its primary health care activities and malaria control programme. Rather, the local people relied more on local shops, ethnomedical practices, and other sources of malaria treatment and prevention. This implies that, as originally formulated, the B1 approach was not relevant to PHC, particularly in meeting malaria control objectives in rural communities in Bondo District. The approach needs to be modified to suit the rural socio-cultural and economic contexts. Primary healthcare agents, primary healthcare education campaigns, Community health workers, and Indigenous social support systems should all be strengthened to improve the poor people's access to community-based healthcare services, and the quality of home-based illness management.