Maasai Response to Mass Drug Administration for Trachoma in a Changing Political Economy in Tanzania

Delivery of global health interventions tackling NTDs are often socially complex. The ‘neglect’ in NTDs is a social dimension and the communities in which the diseases persist are often historically, politically and/or socially marginalized. Trachoma, the commonest infection causing blindness worldwide, is endemic among the Maasai, a historically marginalized tribe in Tanzania. Lack of health facilities and schools in their communities, and the different views about their “development” have impacted on their experiences of health services more generally. Recent incidents in Maasai communities, continue to drive a sense of political subjugation, marginalization and cultural discrimination which fosters distrust in government led activities.

This thesis aims to explore insights and experiences from the Maasai perspective on how trachoma control, specifically MDA, was implemented in relation to their livelihoods. This work draws upon a political-economic approach and the influence of power and authority. This research engaged issues of development and cultural relevancy, within the context of historical power relations. Ethnographic fieldwork was carried out in a Maasai community over 16 months and utilized qualitative methods to explore Maasai’s perceptions and experiences of trachoma; the lived experiences of a Maasai community during a round of MDA; other encounters with health services and development programmes.

This research describes why a ‘one size fits’ all approach is ineffective for a ‘hard to reach community’. Understanding indigenous knowledge may initially help guide control programmes and address local beliefs. Complex social, economic, and environmental barriers to programme implementation are ignored to meet programme goals. Power relations that emerged from colonial and post-colonial political systems in Tanzania and systems of dominance have transcended health care delivery. In light of these findings, this thesis suggests trachoma control programmes and health care delivery more 4 broadly, utilize a more tailored approach to sustainably reach programme targets and meet community needs