Pragmatics of Care: Nordic Standardised Designs for Kenyan District Hospitals



District Hospitals Report, produced by SIDA.
Paper presented at SAH 2024,
Albuquerque, New Mexico,
April 17-21, 2024.
































In the 1970s, Kenya witnessed an unprecedented rise in financial and technical assistance from all parts of the world. Nordic countries, in particular, chose Kenya as one of the focus areas for aid-sponsored projects targeting housing, education and healthcare. For the Nordic donors, these typologies were synonymous with achievements of welfare modernity at home, which could now be exported abroad. For the Kenyan authorities, these investments offered an opportunity to deliver the promised infrastructure expansion, including healthcare, at a low cost. In 1966, the Norwegian Agency for Developmental Aid (NORAD) started works on the Thika Hospital and School of Community Nursing and later collaborated with respective Swedish and Danish agencies on a regional network of rural “health demonstration and training centres” and district hospitals. This infrastructural project responded to the early 1970s WHO’s turn towards a new paradigm of grassroots “Primary Health Care,” spearheaded by the new WHO's Danish director, Halfdan T. Mahler. In the spirit of Nordic pragmatism, Danish and Swedish architects at the Kenyan Ministry of Health proposed to design rural healthcare units around the “minimum basic standards” and standardised construction systems. Rural hospital units would be built locally according to type drawings adapted to topographic and climate conditions, delivering on the promised expansion of rural healthcare of Kenya’s 1974-77 Development Plan. A seemingly lucrative business opportunity for Nordic suppliers, the project encountered many difficulties due to the vastly different geographies, local conditions, and uneven supply of materials and labour. 

Equipped with primary archival materials, this paper then aims to reconstruct a complex web of international bureaucratic and business negotiations involved in the construction of 150 rural health centres. It is particularly interested in these projects as sites of encounter between Kenyan and Nordic visions of technology, modernity and healthcare and often-competing rationales of different local and international actors.
  



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