6 - Grappling with Change in the Age of Transition and Anxiety: Decolonization, Independence, and AIDS

Summary

If the interwar period was characterized by a major shift in both the working and the funding of the colonial health care system, the postwar era saw the colonial state criticized for the interwar financing of health care, which disproportionately burdened the Africans by shifting the financial responsibility of maintaining educational and health institutions and services from the central government to the local authorities. It was also argued by some colonial officials that the state was still focused on repetitive curative work, as opposed to preventative measures directed at improving African living conditions, both in the townships and the rural areas. The criticisms came in the wake of the modernization agenda that was pursued by the colonial state after the war. While the state sought to reinvent itself as the custodian of African health and education needs by investing more funds in the development of health and education facilities, it still hoped to build on the cost-sharing arrangement that had evolved during the interwar period. Hence, Africans had to pay, both as individuals and through their local authorities, to help extend services to African locations in urban and rural areas.

However, the attempt to push through reforms after the war occurred against the backdrop of a very turbulent period in Kenya's history. African militancy reached its explosive height in the Mau Mau uprising. In addition, the politics of decolonization and trade unions’ agitation for better terms and conditions of service for their members challenged the colonial state to deliver on the critical issues of wages, school places, access to health care, and housing in the townships. Once again, discourses on health care during the 1940s and 1950s mirrored the most fundamental tensions that had characterized British colonial rule in Kenya, as well as the immediate pre-independence challenges that both the citizenry and the state faced on the eve of decolonization.

The attainment of independence in 1963, rather than mark the end of the various policy debates of the 1940s and 1950s, reignited them as the postcolonial state sought to assert control over the key sectors: the economy, health, and education. Moreover, the postcolonial period has also seen the subject of health care delivery caught in the larger discourse of the role of international financial institutions and donor agencies in the formulation and implementation of domestic policy by the sovereign state.