Power Relations and Maasai Women’s Access to Social Health Security in Kajiado West Sub-County, Kenya

Peris Chepkurui Kerich, Norvy Paul, Stephen Asatsa


Health is a human right and over the years, national governments have invested heavily to provide citizens with quality, accessible, and affordable health care. Although some aspects of women’s health have improved, there are still important unmet needs. The Maasai community has a patriarchal social structure, where men hold positions of power and authority. Women often have limited decision-making power and may face barriers to accessing healthcare independently. The study examined the effect of power relations on Maasai women’s access to social health security in Kajiado West Sub-County,Kenya. The study employed a mixed-method sequential explanatory design. The target population were Maasai women of Kajiado West Sub County. The sample size was 398, according to the Yamane formula. Questionnaires, interview guides and Focus Group Discussions were used in data collection. The study found a significant negative relationship between power differences and women’s social security for health in Kajiado West Sub-County. In the Maasai community men are in command of family leadership and women obey decisions made by their husbands without questioning. Accessibility to health services is challenging for women since they have to walk far to access health services. The majority of the women are aware of the Linda Mama package and the National Health Insurance Fund national scheme package. The study recommends that there is a need for the government and international and nongovernmental organisations to promote gender equality to address the patriarchy and power relation disparities. There is a need for sensitisation on the rights of women, especially about health.

Full Text:



Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Achadi, E. L., Taher, A., ... & Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75-102. https://doi.org/10.1016/S0140-6736(18)31647-7

Alesane, A., & Anang, B. T. (2018). Uptake of health insurance by the rural poor in Ghana: determinants and implications for policy. Pan African Medical Journal, 31(1). https://doi.org/10.11604/pamj.2018.31.124.16265

Alexander, L. L., LaRosa, J. H., Bader, H., & Garfield, S. (2020). New dimensions in women's health. Jones & Bartlett Learning.

Azevedo M. J. (2017). The State of Health System(s) in Africa: Challenges and Opportunities. Historical Perspectives on the State of Health and Health Systems in Africa, Volume II: The Modern Era (pp. 1-73). https://doi.org/10.1007/978-3-319-32564-4_1

Berchick, E. R., Hood, E., & Barnett, J. C. (2019). Health insurance coverage in the United States: 2018 (p. 2). Washington, DC: US Department of Commerce.

Citaristi, I. (2022). United Nations Population Fund—UNFPA. In The Europa Directory of International Organizations 2022 (pp. 293-296). Routledge.

Davies, S. E., Harman, S., Manjoo, R., Tanyag, M., & Wenham, C. (2019). Why it must be a feminist global health agenda. The Lancet, 393(10171), 601-603. https://doi.org/10.1016/S0140-6736(18)32472-3

Disch, L. J., & Hawkesworth, M. E. (Eds.). (2016). The Oxford handbook of feminist theory. Oxford University Press.

Doctor, H. V., Nkhana-Salimu, S., & Abdulsalam-Anibilowo, M. (2018). Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda. BMC public health, 18(1), 1-12. https://doi.org/10.1186/s12889-018-5695-z

Esho, T. (2019). An exploration of the psycho-sexual experiences of women who have undergone female genital cutting: a case of the Maasai in Kenya. Facts, Views & Vision in ObGyn, 4(2), 121.

Fang, H., Eggleston, K., Hanson, K., & Wu, M. (2019). Enhancing financial protection under China’s social health insurance to achieve universal health coverage. BMJ, 365. https://doi.org/10.1136/bmj.l2378

Fenny, A. P. (2018). Social health insurance schemes in Africa leave out the poor. International Health, 10(1), 1-3. https://doi.org/10.1093/inthealth/ihx046

Ghebreyesus, T. A. (2020). Strengthening our resolve for primary health care. Bulletin of the World Health Organization, 98(11), 726-726A. https://doi.org/10.2471/BLT.20.279489

Gyasi, R. M., Phillips, D. R., & Buor, D. (2020). The role of a health protection scheme in health services utilization among community-dwelling older persons in Ghana. The Journals of Gerontology: Series B, 75(3), 661-673.

Habib, S. S., Jamal, W. Z., Zaidi, S. M. A., Siddiqui, J. U. R., Khan, H. M., Creswell, J., ... & Versfeld, A. (2021). Barriers to access of healthcare services for rural women—applying gender lens on TB in a rural district of Sindh, Pakistan. International Journal of Environmental Research and Public Health, 18(19), 10102. https://doi.org/10.3390/ijerph181910102

He, A. J., & Wu, S. (2017). Towards universal health coverage via social health insurance in China: systemic fragmentation, reform imperatives, and policy alternatives. Applied health economics and health policy, 15, 707-716. https://doi.org/10.1007/s40258-016-0254-1

Heise, L., Greene, M. E., Opper, N., Stavropoulou, M., Harper, C., Nascimento, M., ... & Gupta, G. R. (2019). Gender inequality and restrictive gender norms: framing the health challenges. The Lancet, 393(10189), 2440-2454. https://doi.org/10.1016/S0140-6736(19)30652-X

Hirudayaraj, M., & Shields, L. (2019). Feminist theory: A research agenda for HRD. Advances in Developing Human Resources, 21(3), 319-334. https://doi.org/10.1177/1523422319851286

Kamau, E., & MacNaughton, G. (2019). The impact of SDG 3 on health priorities in Kenya. Journal of Developing Societies, 35(4), 458-480. https://doi.org/10.1177/0169796X19874609

Kenya National Bureau of Statistics. (2018). Kenya integrated household budget survey.

Kiguwa, P. (2019). Feminist approaches: An exploration of women’s gendered experiences. Transforming research methods in the social sciences: Case studies from South Africa, 220-235. https://doi.org/10.18772/22019032750.19

Kimathi, L. (2017). Challenges of the devolved health sector in Kenya: teething problems or systemic contradictions? Africa development, 42(1), 55-77.

Krieger, N. (2012). Who and what is a “population”? Historical debates, current controversies, and implications for understanding “population health” and rectifying health inequities. The Milbank Quarterly, 90(4), 634-681. https://doi.org/10.1111/j.1468-0009.2012.00678.x

Lowe, H., Kenny, L., Hassan, R., Bacchus, L. J., Njoroge, P., Dagadu, N. A., & Cislaghi, B. (2022). ‘If she gets married when she is young, she will give birth to many kids’: a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya. Culture, health & sexuality, 24(7), 886-901. https://doi.org/10.1080/13691058.2021.1893821

Massoi, L. W. (2018). Women in Pastoral Societies and the Church in Kilosa. African study monographs. Supplementary issue, 56, 77-86.

Mohindra, K. S. (2017). Research and the health of indigenous populations in low-and middle-income countries. Health promotion international, 32(3), 581-586.

Mshweshwe, L. (2020). Understanding domestic violence: masculinity, culture, traditions. Heliyon, 6(10), https://doi.org/10.1016/j.heliyon.2020.e05334

Munge, K., Mulupi, S., Barasa, E. W., & Chuma, J. (2018). A critical analysis of purchasing arrangements in Kenya: the case of the National Hospital Insurance Fund. International journal of health policy and management, 7(3), 244. https://doi.org/10.1016/j.heliyon.2020.e05334

Peters, S. A., Woodward, M., Jha, V., Kennedy, S., & Norton, R. (2016). Women's health: a new global agenda. BMJ global health, 1(3). https://doi.org/10.1136/bmjgh-2016-000080

Shah, S., Jha, N., Khanal, V. K., Nepal Gurung, G., Sharma, B., & Shrestha, M. (2022). Utilization of social health security scheme among the households of Illam district, Nepal. Plos one, 17(5), e0265993. https://doi.org/10.1371/journal.pone.0265993

Sikweyiya, Y., Addo-Lartey, A. A., Alangea, D. O., Dako-Gyeke, P., Chirwa, E. D., Coker-Appiah, D., ... & Jewkes, R. (2020). Patriarchy and gender-inequitable attitudes as drivers of intimate partner violence against women in the central region of Ghana. BMC public health, 20, 1-11. https://doi.org/10.1186/s12889-020-08825-z

Tandrayen-Ragoobur, V. (2021). Building the patriarchy index for sub-Saharan Africa: Perceptions and acceptance of violence matter most. Patriarchy and Gender in Africa. Lexington Books.

Taylor, Y. J., Liu, T. L., & Howell, E. A. (2020). Insurance differences in preventive care use and adverse birth outcomes among pregnant women in a Medicaid no expansion state: a retrospective cohort study. Journal of women's health, 29(1), 29-37. https://doi.org/10.1089/jwh.2019.7658

World Health Organization. (2018). Delivering quality health services: A global imperative. OECD Publishing.

DOI: https://doi.org/10.5296/ijsw.v10i2.21316


  • There are currently no refbacks.

Copyright (c) 2023 Peris Chepkurui Kerich, Norvy Paul, Stephen Asatsa

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

International Journal of Social Work  ISSN 2332-7278  E-mail: ijsw@macrothink.org

Copyright © Macrothink Institute 

To make sure that you can receive messages from us, please add the 'macrothink.org' domains to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', please check your 'spam' or 'junk' folder.