The Malia Coast Comprehensive Health Center

Abstract

Malia, a poor rural community in the State of Hawaii, had no health facility; thus in the early 1950s Malia residents asked the federal government to assist them in building and operating a health center. From 1950 to 1970, the federal government provided Malia with no assistance. The Malia community, however, organized the Malia District comprehensive Health and Hospital Board, Inc. (Board). Composed totally of residents, the Board's purpose was to upgrade health care in Malia. Then in 1972, federal government agencies agreed to assist Malia. The Regional Medical Program, the Department of Health, Education and Welfare, and Model Cities each awarded grants to the Board to design, build and operate a neighborhood health center. To initiate the grants, the funding agencies recognized the Board as the official policy-making organization for the proposed health center; and the Board agreed to fulfill numerous reporting and monitoring conditions for each agency. The Board then hired a project director to design the health center. When completed, the design specified plans for the construction of a primary care building, and the implementation of a community-oriented health program. The initial project director then resigned, and the Board selected a new director to implement the health program. The new director was unable to establish effective working relations with the Board and he also resigned. The Board then hired the Board president, Edward Kahele, as the new project director. Although Kahele had the full support of the Board, he had neither the formal training nor the administrative experience to implement the health program. Consequently, he failed to accomplish key program goals. Operating and personnel policies were never finished; working agreements with hospitals and health providers were never established; the required prepaid health plan was never drawn up; and the health program was never expanded. The failure to accomplish these goals led the funding agencies to insist that Kahele be replaced with a qualified administrator. The Board, however, refused, feeling that the funding agencies were trying to gain direct control of the Center. An impasse resulted and the funding agencies cut off all operating funds. The Center was forced to close. After the closing, the Board agreed to the funding agencies stipulations and the Center was reopened. The Board then reorganized itself and hired a new project director. The Malia case history illustrates problems encountered by many projects. Some of these problems include conflicts between the indigenous community and the outside funding authority, organizational tension created by multiple funding sources, problems of coordination and supervision stemming from an inadequate design, and the antagonism between experts and lay policy-makers.