Maasai Response to MDA for Trachoma- a Political Economy of Public Health Perspective

Trachoma, the commonest infection causing blindness worldwide, has greatly decreased in many countries due to MDA.  Yet rates remain high in Tanzania.  The Maasai tribe are a majority of the population in trachoma endemic areas in Northern Tanzania where uptake of MDA is low. Reasons for this are not clearly understood.  There is a need to understand non-participation from the perspective of the Maasai.  Understanding the lives and health care experiences of Masaai is important. Lack of health facilities and schools in their communities, poor health services in urban settings due to language barriers and the different views about their “development” have impacted on their experiences of health services more generally.  Additionally, traditional medicine is widely practiced possibly due to isolation from centres of development and a strong cultural identity.  Further to this, recent reports indicate a continued sense of political subjugation, marginalization and cultural discrimination of Maasai, which fosters distrust in government led activities.

This is an ethnographic study in which I lived in a Maasai community in Longido District for 13 months since September 2016, interviewing community members, observing MDA, trichiasis surgery outreach and other health services all while living and understanding the daily lives of the Maasai.  Through this I was able to explore reasons for poor uptake including the social, political and historical experience of the Tanzanian Maasai, and specifically how perceptions, experiences and responses to health programs, specifically MDA for trachoma, are impacted by the changing political and economic context of the Maasai. 

This research utilizes a political economy of health framework to take a public health approach to understanding Maasai response to MDA. The Tanzania Ministry of Health recognizes the need to change their approach to MDA for nomadic and marginalized communities.  These findings will further inform program development for such populations in trachoma endemic areas and more broadly for other NTDs and related health interventions.