Is faith-based health care a stopgap, or a long-term partnership?

BURLINGTON, Vt. — For many working in faith-based health care, the sector’s role in low- and middle-income countries seems self-evident.

“When you start from the faith perspective, you say, ‘well, why isn’t the whole world aware?’ We’re already providing anywhere from 20-70% of health services in many low- and middle-income countries,” said Doug Fountain, executive director of Christian Connections for International Health, a forum for Christians working in global health.

While faith-based health services are widespread, often sophisticated and diverse operations, their overall contribution to a country’s health system can be difficult to describe and varies widely from place to place. In some cases, that lack of information has limited the faith sectors’ involvement in government and donor-driven plans to strengthen health systems and expand access to health care, faith-based advocates say.

That concern has led CCIH and other organizations to begin mapping faith-based health providers in their global networks, in order to assemble a clearer picture of both their geographic reach and their qualitative contributions to health service delivery.

The challenge is to, “describe the value addition of the faith sector in a way that makes sense for the donor communities,” Fountain said.

By gathering and disseminating better data about faith-based health care, they hope to facilitate a more complementary relationship between two health systems — public and faith-based — that have often operated in parallel, but not always in partnership.

The information that does exist about the role of faith-based organizations in providing health services — like statistics of the percentage of hospital beds they provide — can be helpful, but often fails to capture important nuance, Fountain said. For example, in many countries faith-based services operate in predominantly rural, hard-to-reach areas, which a nationwide percentage fails to capture.

CCIH set out simply to map where its members are working, but the goal is to describe “how the faith-based health system really works,” Fountain said.

That information can be of immediate, practical use.

In Uganda, a huge amount of medical procurement is run through Joint Medical Store, an NGO established in 1979 by the Uganda Catholic Medical Bureau and the Uganda Protestant Medical Bureau. In the COVID-19 pandemic, if a donor wanted to ensure Ugandan health facilities had sufficient access to personal protective equipment, the best way to start would not be surveying hundreds of hospitals, but with the JMS, Fountain said.

“I want to make sure that everybody knows who they are, and what they do, and what’s the value that they add so that people can connect with them,” he said.

A qualitative difference

In many cases, the services faith-based health providers are qualitatively different from what the public health sector provides — and can help fill gaps within the government-run system, said Mwai Makoka, program executive for health and healing at the World Council of Churches.

“Our mission is the same, but our motivations are different,” Makoka said. “The government’s looking for cost effectiveness of delivering health care. For us, churches may do some things which may not be cost-effective, but they are serving the marginalized.”

That can mean that church hospitals or missionary-run health services operate in geographically isolated places, where the “location is not decided by anybody sitting at the government headquarters. It's based on the needs on the ground,” Makoka said.

Faith-based providers might also serve particular demographics that struggle to get their needs on the agenda of the public health system. In many low- and middle-income countries, it is often faith-based groups that serve people with disabilities.

For example, in Makoka’s home country of Malawi, he said all of the schools for the deaf are church schools, as is the teacher training school for special needs education. In Chennai, India, he visited a church-run workshop for prosthetic limbs, which drew patients from 2,000 kilometers away.

“It’s not only geographical isolation, but programmatically you find that there are some niches that easily fall through the cracks of the government,” Makoka said.

According to Fountain, the difference comes down to faith-based groups taking a “holistic” approach to health care, which addresses “the integration of physical, emotional, and spiritual factors.”

For governments and international organizations working on health challenges that require some form of behavior change, faith-based groups can sometimes access a deeper level of trust with the communities they serve, Fountain said.

“The next frontier, frankly, is to really work with the church on vaccine hesitancy,” he added.

A matter of philosophy

Makoka is also leading a mapping initiative at the World Council of Churches, which aims to identify the Christian health associations present in different countries, and then work with them to source more detailed information about their affiliated faith-based health providers. The goal is a more dynamic, up-to-date picture than what currently exists.

There are at least two reasons for assembling that information, Makoka said. When he led the Christian Health Association of Malawi, Makoka found that simply gathering information about individual, often isolated health centers into a common report — which he then distributed back to them — helped build a sense of solidarity among an otherwise disparate network.

The second reason is to give these networks a stronger voice with the international organizations and governments that plan and budget health systems investments.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria, for example, might send a delegation to visit one of their partner countries, but these visits are often managed and coordinated solely by the health ministry. If the organization is in possession of a report showing that faith-based health providers account for 20-70% of a country’s health services, they might be more inclined to include a church hospital in their itinerary, Makoka said.

That increased exposure might help ensure faith-based health providers see their specific needs reflected in health systems investments.

Whether faith-based health providers ought to have a central role in those plans and investments, “comes down to your philosophy,” said Fountain.

One philosophy says: “Ultimately, the government is the provider of health services. They’re the ones that are responsible for the public’s health, and therefore anything that a faith-based organization is doing is simply biding time until resources exist for the government to build it.”

That view is widely held among European institutions, which tend to advocate for a public-oriented health care system, Fountain added.

The faith-based argument counters that the sector’s focus on holistic care, its existing geographic reach, and the potential for creative solutions to health care to emerge from small to mid-sized operations should position these groups as long-term components of countries’ health systems, Fountain said.

“If you’re planning modern resources, and you’re planning for the future of health, you shouldn’t be excluding this major, significant player in health. You should be figuring out how you want to work with them,” Fountain said.

Trump administration push

In the last three years, the faith-based community has found a strong advocate in U.S. President Donald Trump’s administration.

“There’s no question that much of the effective health care that’s delivered is delivered and associated with faith-associated health systems,” Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, told attendees of CCIH’s annual conference last year.

“How they can begin to form strategic partnerships with the public health system is something I think would be of benefit,” he added.

Redfield is part of a powerful cadre of U.S. global health leaders drawn from the ranks of the faith community and strongly in favor of seeing more U.S. global health funding directed to faith-based organizations. Deborah Birx, the U.S. Global AIDS Coordinator, and Alma Golden, the U.S. Agency for International Development’s global health lead, also have close ties to the evangelical community.

Birx has undertaken an effort to direct 70% of PEPFAR’s resources to indigenous organizations, and has been adamant that faith-based groups ought to be a more central focus of the HIV/AIDS initiative’s programming.

USAID’s “New Partnerships Initiative,” launched under former Administrator Mark Green, is an effort to bring new and “underutilized” partners into the agency’s funding process, which includes channeling more funding to faith-based groups.

“It is unmistakable that there is a strong faith presence there. That’s good if your goal is to make sure that the faith sector is well-represented and has a voice … The challenge will be for that not to be overly associated with the current administration,” Fountain said.

The faith community witnessed something similar in the transition from President George W. Bush to President Barack Obama. When Obama took office, global health and development officials were suddenly relieved of the pressure to work closely with the faith community, and so the pendulum swung away from supporting faith-based programs. Over the ensuing years, the Obama administration also came to see the value in these groups, and worked with them more closely, Fountain said.

Faith advocates will need to make the case that their community offers something valuable at the programmatic level, which should be sustained regardless of who is in office, Fountain said.

“That’s what I hope we can see, but in our divisive and polarized society, that is something that I’m concerned with,” he added.

Devex, with support from our partner GHR Foundation, is exploring the intersection between faith and development. Visit the Focus on: Faith and Development page for more. Disclaimer: The views in this article do not necessarily represent the views of GHR Foundation.