In the period before 1920, the colonial state operated on the premise that it was the sole authority on matters of public health. The rest of the society was projected merely as a group of passive victims or agents waiting to be told what to do or to be acted upon by the state. By the middle of the 1920s, the state opted for a combination of preventative, curative, and clinical approaches. The effectiveness of the shift and the adoption of a multifaceted approach necessitated winning the trust of the community and recognizing it as an invaluable partner in the campaign to eradicate epidemics. Thus, an inclusive approach based on the foundation of joint efforts among local communities, the colonial administration, medical authorities, and experts began to gain ascendancy in the middle of the 1920s, reaching its apogee in the 1930s during the height of the Great Depression. By the end of the 1930s, health care in colonial Kenya had, by and large, assumed the basic organizational structure that would not only outlive colonialism but also inform health care in the postcolonial period.

This chapter examines African proactive involvement in shaping the form and structure of colonial health care during the interwar period, against the backdrop of the Great Depression. The discussion is organized into three main sections. The first section focuses on how the community became involved in the colonial state's crusade-driven and curative public health measures. In the next section, the onset of the Depression is examined, as are African initiatives, which sustained the tempo of expansion of colonial health facilities and services in an era of economic deprivation and scarcity. The last section examines the rise and fall of eugenics as social medicine in colonial Kenya against the backdrop of the politics and economics of the interwar period.

The warm enthusiasm that inaugurated the introduction, by the adherents of Western biomedicine, of “germ” theory into the colonial health care discourse during the first two decades of the twentieth century began to wane once it was realized that the emphasis on the laboratory and the hospital was not yielding immediate results.