The paper begins the review with a discussion on the significance of this strategic time in history as the world transits from the far from reached MDGs to the SDGs to analyze the roles of faith based health care in the strengthening of Africa's health care systems with a focus to further foster enduring partnerships between national systems and faith based health care(FBHPs) .
The paper supports the idea that (FBHPs) continue to be an integral part of health provision systems in fragile health systems and importantly in sub Saharan Africa.
In the words of James Wolfensohn of the World Bank (2002) “half the work in education and health in sub Saharan Africa is done by the church…but they don't talk to each other, and they don't talk to us.”
In a way we lost track of the work and contributions of Faith-based providers of health and education in the world of research and policy despite the fact that Christian and Islamic hospitals were some of the first modern health-care providers to be founded.
Also post colonization, many developing economies have had to rely on FBHPs to maintain health care provision irrespective of the national restructuring of health systems.
The recent tilt towards public health and the lack of total trust in the FBHPs as a result of proselytization are some of the reasons proffered by the review for the seeming neglect of the work done by FBHPs.
The paper focussed its review on sub Saharan Africa and Christian Faith based health providers due to the lack of robust evidence for other types of faith based care.
Some highlights of the review:
- FBHPs engaged in health from a policy level in the past decade have received more attention.
- The scarcity of systematic and consistent data for FBHPs.
- Evidence of higher level of satisfaction by households from FBHPs than from public counterparts.
- Lower than expected market shares by FBHPs.
- The key roles played by FBHPs in many African countries, and moreso in fragile health systems.
- Limited by certain weakness, finances, problems with adapting to changing health settings.
- The appreciation of their contribution to health care is clouded by controversies tied to their faith.
- The need to refrain from broad generalisations about faith-based organisations.
- The need for more partnership oriented policy implementation strategies for engaging and relating with FBHPs.
- The need for more intense research on the contributions of FBHPs to universal health coverage at national levels.
The review alluded to the fact that most of the evidence available about the work of faith based organizations is in relation to their work on HIV/AIDS. This limits the scope of those who seek to understand the functioning and effects of specific health systems.
At the beginning of the 21st century, minimal information was available about the number of available FBOs and their scope of operation.
At the beginning of the 21st century, minimal information was available about the number of available FBOs and their scope of operation.
Sadly comprehensive and consistent evidence about their scope of work and activities is still limited today.
However a general consensus by most of the stake holders in the health sector is that Faith based organizations and NGOs constitute a major force in health care delivery across Africa and in post conflict zones when compared with other health care providers.
In a comparison between FBOs in the Kenyan Mukuru settlement and their secular counterparts; a third of the 194 programs focused on HIV/AIDS were classified as faith based.
Generally, FBOs have been active in all aspects of public health : immunization, anti malarial campaigns, child and maternal health services, and tuberculosis.
However the comparative magnitude of this involvement is not available.
To evaluate the magnitude of their involvement historically, FBOs during the era of the colonial masters dominated the health systems; in terms of number of facilities and magnitude of services.
Post independence, FBHPs have experienced substantial shifts in this role with new national governments taking strong leadership roles and the rapid expansion of public systems amidst a series of health sector reforms.
The governance of FBHPs was thereafter transferred from international denominational bodies to local churches, resulting in substantially reduced support from traditional sources and sometimes reduced growth of FBHP services. This also led to a drastic reduction in the source of funds to run FBOs.
FBHPs currently source for funds for their services from government resources, user fees from patients, development assistance from bilateral and multilateral donors, and funding and in-kind contributions from within-country faith groups and local communities.
Some partnerships; albeit reluctantly have been forged between FBHPs and governments
which have resulted in improved public–private awareness.
Such partnerships between ministries of health and Christian organizations exist in Chad, Malawi, Uganda, Tanzania, Zambia, Lesotho, Benin, Ghana, Kenya, and Cameroon.
With FBOs committing to support public health sector goals and priorities (in particular, serving poor people in hard-to-reach areas), and in return, the government commits to some kind of financial compensation, often in the form of salary support, and usually negotiated to match bed-based market-share estimates.
Needless to say several of the partnerships are strained, and frothed with failure to fulfil service-level agreements and conflicts with finance and human management systems.
FBOs funds are difficult to track, although efforts are being made to track them. It is however clearly evident that FBOs have several means of raising funds formally and informally and within local borders and internationally.
Several studies have shown that many of the Faith based initiatives are run with local community based funds and resources (including local volunteers) with minimal contributions from external sources.
Many FBHPs were started with the aim to serve the poor in hard-to-reach areas, this intent often times is controversially associated with other motives such as proselytism.
Evidence, however lends credence to the presence of FBHPs in remote rural areas in Africa. As a result of a commitment to serve the underprivileged or to fill a gap in areas not already met by government services.
Household surveys from 14 African countries show that FBHPs seem to serve poor people slightly more than public providers (with 17% of patients in the poorest quintile).
There were higher household satisfaction rates with FBHPs.
Most studies show that this might not be directly related to religion.
Most studies show that this might not be directly related to religion.
Few indications suggest that patients choose FBHPs based on religious affiliation.
Lower out-of-pocket costs for households and perceptions of a higher quality of service than obtained at public health providers are some of the determining factors.
High quality of service is often associated with attention paid to the dignity of patients as well as more compassionate care than received elsewhere. This comparison is poorly subtantiated by evidence and the motivations are not clear as FBOs workers tend to work for longer hours for lesser pay due to reasons that may have a relationship to their faith.
The review being focused on the growing evidence of the nature of health care provided by faith-based health providers in Africa, hence the reviewers believe that the comparative weaknesses and potential negative effects associated with some FBHPs should also be examined.
Published work commonly states that FBHPs can be of poorer quality than their public counterparts in some locations and that they may have weak governance in terms of financial and human resource management due to the employment of managers and administrators due to their religious affliations and not for skills.
More so the mixing of theology with health-service policy have produced negative health effects especially as regards sexual and reproductive health in the past.
Emerging evidence from studies have shown that FBHPs are still very relevant and play key roles in the rebuilding of fragile health systems, although not much is known about how they function.
More quantitative and qualitative data is needed to provide support at management and policy levels on the day to day functioning of FBHPs within their health systems.
The review proposed the need for the abandonment of broad generalisations of the magnitude and character of FBOs and further proposed that an understanding should be sought of the interactions of the management practice, organisational culture, pharmaceutical supply, cost recovery, and human resource management, and how these affect (clinical) quality, satisfaction, and use, and then how this affects access, reach to poor people, and broader goals such as universal health care.
Non-Christian providers, non-mainstream religious groups, and non-anglophone contexts are worryingly absent from the present analyses; this missing information is urgently needed if FBHPs are to align with their national governments in a way that strengthens the health system.
As the world deliberates on restructuring health care in sub Saharan Africa. This is a good time to examine the roles of faith based health care providers and faith based organizations so as to avoid duplication of care and available resources, and perhaps we may be able to come up with ways to benefit from the existing structures and pull resources together to build new programs, strategies, policies and initiatives on frame works provided by FBHPs and FBOs for an enduring Health system in Africa.
The review being focused on the growing evidence of the nature of health care provided by faith-based health providers in Africa, hence the reviewers believe that the comparative weaknesses and potential negative effects associated with some FBHPs should also be examined.
Published work commonly states that FBHPs can be of poorer quality than their public counterparts in some locations and that they may have weak governance in terms of financial and human resource management due to the employment of managers and administrators due to their religious affliations and not for skills.
More so the mixing of theology with health-service policy have produced negative health effects especially as regards sexual and reproductive health in the past.
Emerging evidence from studies have shown that FBHPs are still very relevant and play key roles in the rebuilding of fragile health systems, although not much is known about how they function.
More quantitative and qualitative data is needed to provide support at management and policy levels on the day to day functioning of FBHPs within their health systems.
The review proposed the need for the abandonment of broad generalisations of the magnitude and character of FBOs and further proposed that an understanding should be sought of the interactions of the management practice, organisational culture, pharmaceutical supply, cost recovery, and human resource management, and how these affect (clinical) quality, satisfaction, and use, and then how this affects access, reach to poor people, and broader goals such as universal health care.
Non-Christian providers, non-mainstream religious groups, and non-anglophone contexts are worryingly absent from the present analyses; this missing information is urgently needed if FBHPs are to align with their national governments in a way that strengthens the health system.
As the world deliberates on restructuring health care in sub Saharan Africa. This is a good time to examine the roles of faith based health care providers and faith based organizations so as to avoid duplication of care and available resources, and perhaps we may be able to come up with ways to benefit from the existing structures and pull resources together to build new programs, strategies, policies and initiatives on frame works provided by FBHPs and FBOs for an enduring Health system in Africa.
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