Dilemmas of modernization in primary health care in Western Samoa.

This paper examines the historical development of rural women's associations (komiti tumama) in Western Samoa under New Zealand's colonial administration. These associations came to be the backbone of public health programmes and played a crucial role in preventive medicine at the village level: they embodied all the principles now subsumed under the rubric 'primary health care'. The successful growth of a rural, self-help system of primary health care in Samoa resulted from the use of traditional institutions to promote new practices in sanitation and health care. The system rewarded and fostered village autonomy and enhanced the status of married women. This paper argues that a stagnation in community-based health programmes linked in part to an increasing unwillingness of rural women's associations to support such programmes has occurred most particularly in the past decade. It is proposed that this stagnation may be related to overall problems of modernization in the Western Samoan economy, professionalization and bureaucratization of the national health services, and the ritualization of certain key practices (such as the inspection of village sanitation) in preventive medicine by rural women. The consequences of the stagnation for rural people have been a greater dependence upon curative medical services, and a loss of clearly defined roles for women's institutions in primary health care. The historical drift has been away from rather than towards the PHC model as espoused today by the World Health Organization and as initiated by the New Zealand administration in colonial times.