Network development for non-state health providers: African Christian health associations

ABSTRACT

Substantial effort has been put into forming and strengthening national networks of non-state, non-profit health providers in lower- to middle-income contexts. Christian health associations (national umbrella networks of faith-inspired health providers) were first established in the 1950s, and are currently present in an estimated 23 of the 54 countries in Africa. The establishment of CHAs was equally encouraged by faith-based health providers, governments, and external stakeholders. CHAs look different in each context, but perform similar roles: networking diverse institutions and facilities together into a loose system; and establishing a more cohesive sector to simplify and strengthen advocacy and engagement with the government.     

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

ABSTRACT

Despite the benefits of antenatal care, evidence from sub-Saharan Africa suggests that women often initiate these services after the first trimester of pregnancy and do not complete the recommended number of visits. This study examines the impact of mobilising faith-based and lay leaders to address the socio-cultural barriers to antenatal care uptake in northern Ghana in the context of a broader child survival project. A quasi-experimental design was used, and data were analysed using a difference-in-differences approach. The results presented in this article indicate the potential for faith-based and lay leaders to promote uptake of maternal and child health behaviours.     

Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

ABSTRACT

In sub-Saharan Africa many individuals rely on non-state health providers, and engagement between state and non-state providers is increasingly common. Little analytic work has been done on the varied models of engagement, resulting in a lack of clarity about the promises and challenges of public–private engagement (PPE) for health. Despite their prevalence, PPEs often fail. Faith-based health providers (FBHPs) form a significant proportion of the non-state health sector in sub-Saharan Africa, and the number of partnerships with FBHPs is increasing. Building on a prior systematic review project that developed a typology of organisational models for PPE for health, this article reports on a secondary analysis, highlighting PPE initiatives with FBHPs.     

A comprehensive approach to providing services to survivors of sexual and gender-based violence in Democratic Republic of Congo: addressing more than physical trauma

ABSTRACT

The eastern Democratic Republic of Congo (DRC) is impacted by a prolonged conflict and humanitarian crisis. Sexual and gender-based violence (SGBV) affects an estimated 39.7% of women and 23.6% of men in the region, and is associated with serious medical, psychological, and socio-economic outcomes for survivors and communities. IMA World Health, a faith-based non-profit organisation, implements a USAID-funded project, Ushindi, which is a collaborative effort with three national NGOs and one technical partner in response to SGBV in eastern DRC. The consortium provides a comprehensive package of services to SGBV survivors, focusing on medical, emotional, psychological, legal, and socio-economic needs.     

Faith-based HIV response in post-Soviet Eastern Europe: the case of Channels of Hope in Russia,Romania, and Armenia

ABSTRACT

Most of the data available on faith-based HIV response focus on Africa, which is the heart of the pandemic. This article investigates faith-based community-level HIV responses within Eastern Europe, by studying the implementation of World Vision International’s “Channels of Hope” faith-based HIV intervention. The intervention approach was developed in a high HIV-prevalence setting (South Africa) and then implemented across sub-Saharan Africa and elsewhere – including three low HIV-prevalence Eastern European settings (Armenia, Romania, and Russia). Drawing from implementation and evaluation research, this article explores the nature, challenges, and potential of faith-based HIV response within low-prevalence, post-Soviet contexts.     

The historical contribution of faith-based health providers in the Ecuadorian health system: an overview of the evidence

ABSTRACT

Faith-based health providers (FBHPs) have historically shaped the national health system in Ecuador, yet there is little robust evidence of this role, or their current contribution to the national health system. This article situates FBHPs in the Ecuadorian health system, using secondary analyses of national health surveys to consider changes in contribution from 1998 to 2014, and synthesising this with secondary literature. The research confirms the important role that FBHPs have historically played in Ecuador, but also shows that their current role needs to be better understood if universalisation of health service coverage is to be achieved.     

The unhealthy divide: how the secular-faith binary potentially limits GBV prevention and response

ABSTRACT

While progress has been made in creating conversations between the secular and faith actors involved in developmental issues, a distinct binary still exists. This could potentially be limiting a holistic response to gender-based violence, a global public health, development, humanitarian, and human rights issue. This article explores how perceptions of this binary – faith versus secular – are understood to impact GBV prevention and response efforts. Drawing on interviews conducted during a scoping study, the opinions and experiences of actors from faith-based organisations and academic institutions are used to shed light on how the faith-secular binary is being upheld and challenged, and how it is perceived to be impacting holistic GBV prevention and response.     

Promoting inclusive development in Ghana: disabled people’s and other stakeholders’ perspectives

This article highlights barriers to inclusive development from the perspective of disabled people, as well as staff of NGOs and government agencies. A qualitative study was conducted between August 2011 and September 2012, and in September 2013, in rural and urban areas in Greater Accra and Eastern regions in Ghana. The research shows that inaccessible public infrastructure and services, negative attitudes of service providers, little political will, limited capacity of development agencies, and lack of multi-agency coordination in the disability development sector were barriers to disabled people’s inclusion and participation in development processes.     

Evolution of input supply and service hubs in dairy development at Ada'a milk shed in Ethiopia

Efficient input supply and service delivery may call for a hub approach where all the necessary inputs and services are supplied in a coordinated manner, either by a single supplier or by several and separate entities in a given geographical location accessible to beneficiaries. Based on experience from Ada'a milk shed in central Ethiopia, this paper assesses the evolution of input supply and service provision in the dairy sub-sector, focusing on coordination and the degree of competition among different actors at different levels in the value chain over time. Data were collected from key value chain actors engaged in provision of input supply and output marketing services in Ada'a milk shed. The major lesson is that the development of coordinated input supply and service delivery by different business entities or under a single business entity may not emerge at once, but through a gradual evolution. This depends on the level of demand for the inputs and services as determined by the degree of demand for milk and milk products, and the economies of scale input suppliers and service providers could attain from the expansion of demands for these inputs and services. Moreover, at the early stage of a hub development, collective actions and integration of services and marketing within a business organisation could be the main strategy to attain efficiency. But, once the demand for inputs and services has grown, competition among different entities will lead to more efficient input supply and service delivery. In general, where there is an increasing demand for inputs and services, there is a faster development of input supply and service provision by private actors and collective actions in a more competitive way. Role of the public sector could change gradually from provision of inputs and services to coordination, capacity building, quality control, and regulation.

Évolution des plateformes d'approvisionnement en intrants et de services dans le développement du secteur de la production laitière dans la laiterie d'Ada'a, en Éthiopie

Pour une fourniture d'intrants et une prestation de services efficaces, il peut se révéler nécessaire de mettre en ?uvre une approche axée sur une plateforme dans le cadre de laquelle tous les intrants et services nécessaires sont fournis de manière coordonnée, soit par un fournisseur unique soit par plusieurs entités séparées, dans un lieu donné accessible aux bénéficiaires. Sur la base de l'expérience de la laiterie d'Ada'a, en Éthiopie, cet article évalue l'évolution de la fourniture d'intrants et de la prestation de services dans le sous-secteur laitier, en se concentrant sur la coordination et sur le degré de concurrence entre différents acteurs et à différents niveaux de la chaîne de valeur au fil du temps. Des données ont été recueillies auprès d'acteurs clés de la chaîne de valeur actifs dans la fourniture d'intrants et dans la prestation de services de commercialisation de la production dans la laiterie d'Ada'a. Le principal enseignement est que le développement d'une fourniture d'intrants et d'une prestation de services coordonnées par différentes entreprises ou dans le cadre d'une entité commerciale unique peut ne pas avoir lieu tout d'un coup, mais au fil d'une évolution progressive. Cela dépend du degré de demande concernant les intrants et les services, tel que déterminé par le degré de demande de lait et produits laitiers, et par les économies d'échelle que les fournisseurs d'intrants et les prestataires de services pourraient obtenir grâce à l'expansion de la demande de ces intrants et services. De plus, au stade initial de la mise en ?uvre d'une plateforme, les actions collectives et l'intégration des services et de la commercialisation dans une organisation commerciale pourraient constituer la principale stratégie pour arriver à l'efficacité. Mais, une fois que la demande en intrants et en services s'est accrue, la concurrence entre différentes entités engendrera une fourniture d'intrants et une prestation de services plus efficaces. En général, lorsqu'il y a une demande croissante d'intrants et de services, il se produit un développement plus rapide de la fourniture d'intrants et de la prestation de services par des acteurs privés dans une optique plus concurrentielle. Le rôle du secteur public pourrait évoluer progressivement, de la fourniture d'intrants et de services à un rôle de coordination, de renforcement des capacités, de contrôle de la qualité et de réglementation.

Evolución de la oferta de insumos y de los centros de servicios en el desarrollo de lácteos en la cuenca lechera de Ada en Etiopía

Para llevar a cabo de manera eficiente la oferta de insumos y la entrega de servicios puede requerirse un centro de servicios cuya ubicación sea accesible a los beneficiarios, a partir del cual los mismos sean suministrados de manera coordinada, ya sea a través de un proveedor único, o bien, a través de varios entes separados. Apoyándose en la experiencia de la cuenca lechera de Ada, localizada en el centro de Etiopía, el presente artículo valora la evolución de la oferta de insumos y de la entrega de servicios en el subsector de lácteos, centrándose en la coordinación y en el grado de competitividad mostrado durante varios años por distintos actores ubicados en diferentes estratos de la cadena de valor. La información fue recopilada de actores clave de la cadena de valor en la cuenca lechera de Ada, quienes proveen insumos y servicios de comercialización de productos. El aprendizaje más importante que ha dejado esta experiencia es que: el desarrollo de la oferta de insumos y de la entrega de servicios – realizadas de manera coordinada por distintas empresas o por una sola – puede no surgir inmediatamente, sino después de una lenta evolución. Ello depende del nivel de demanda de insumos o servicios que, a su vez, depende tanto de la demanda de leche y de productos lácteos como de las economías de escala que pudieran obtener sus proveedores a partir de la expansión de la demanda de estos productos. Asimismo, durante las etapas iniciales del desarrollo de un centro de servicios, las acciones colectivas, la integración de servicios y la comercialización centradas en una sola empresa, podrían constituir la estrategia más importante para mejorar la eficiencia. Sin embargo, una vez que la demanda de insumos y servicios haya crecido, la competencia entre distintas entidades producirá una oferta y una entrega de los mismos más eficiente. En general, en aquellos lugares en que exista una demanda creciente, habrá un desarrollo más rápido de la oferta de insumos y de la entrega de servicios por parte de los actores privados, además de acciones colectivas más competitivas. En consecuencia, el rol del sector público podría modificarse gradualmente, pasando de ser proveedor de insumos y servicios a ser la instancia que coordine, fortalezca capacidades y vigile el control de calidad y las normas.

Evolução dos centros de abastecimento de insumos e serviços no desenvolvimento do setor de laticínio da região produtora de leite de Ada'a, na Etiópia

Uma oferta eficiente de insumos e de serviços pode demandar um centro em que todos os insumos e serviços necessários sejam ofertados de maneira coordenada, seja através de um único fornecedor ou de várias entidades separadas em uma dada área geográfica acessível aos beneficiários. Com base na experiência da região produtora de leite de Ada'a situada na região central da Etiópia, este artigo avalia a evolução da oferta de insumos e de serviços no sub-setor de laticínios, concentrando-se na coordenação e grau de competição entre diferentes agentes em níveis diferentes da cadeia de valores no decorrer do tempo. Os dados foram coletados a partir de agentes-chave da cadeia de valores engajados na oferta de insumos e serviços de marketing na região produtora de leite de Ada'a. A principal lição é que o desenvolvimento da oferta coordenada de insumos e de serviços através de diferentes entidades empresariais ou através de uma única entidade empresarial pode não surgir de uma só vez, mas sim ter uma evolução gradual. Isto depende do nível de demanda dos insumos e serviços, que é determinado pelo grau de demanda de leite e de produtos lácteos, e as economias de escala que os fornecedores de insumos e de serviços podem obter a partir da expansão de demandas por estes insumos e serviços. Além disto, na fase inicial do desenvolvimento de um centro, ações coletivas e integração de serviços e marketing dentro de uma organização empresarial podem ser a estratégia principal para se obter eficiência. Porém, após a demanda por insumos e serviços ter crescido, a competição entre entidades diferentes levará a uma oferta de insumos e de serviço mais eficiente. Em geral, quando há uma demanda crescente por insumos e serviços, há um desenvolvimento mais rápido na oferta de insumos e serviços por agentes privados e ações coletivas mais competitivas. O papel do setor público poderia mudar gradualmente da oferta de insumos e serviços para a coordenação, capacitação, controle de qualidade e regulação.     

David and Goliath: dismantling inequalities within faith-based cross-sector partnerships

This article reports on a research project that explored the internal dynamics of a faith-based and cross-sector partnership when different levels of organisational resources and capacity exist. A case of a three-way partnership between a faith-based, a for-profit, and a non-profit organisation is analysed. Through participant observation, interviews, and an examination of secondary data using grounded theory and the constant comparison method of analysis, an assessment of how resources impacts partnership structure, agenda/goal setting, roles, and responsibilities are highlighted and framed to demonstrate the inequalities in partnership outcomes. Furthermore, a framework for how to infuse structural equality into these partnerships is discussed.     

Female genital cutting in Egypt: drivers and potential responses

ABSTRACT

Female genital cutting (FGC) is a major issue at the interplay of faith and health in development. The practice is in part faith-inspired, and has clear negative health impacts. The prevalence of FGC remains especially high in Egypt. This article reflects on some of the factors that lead to the perpetuation of the practice by analysing data from the 2014 Survey of Young People in Egypt. The focus is on whether religiosity, acceptance of traditional gender roles and discrimination, attitudes towards women’s autonomy, and age at marriage affect attitudes towards FGC, controlling for other factors. The results suggest that all these factors do indeed play a role.     

Domains of faith impact: how “faith” is perceived to shape faith-based international development organisations

Increasing interest in faith-based international development organisations (FBOs) recently has improved understanding of these agencies. One reason for complex, often contradictory findings is the lack of frameworks analysing the interactions of worldviews on organisational structures, processes, and behaviours of agencies, and development outcomes. We utilise Lincoln's (2003. Holy Terrors: Thinking about Religion after September 11. Chicago: University of Chicago Press) four “domains of religion” to explore how the literature reports faith impacting the shape of development FBOs’ structures, behaviours, and outcomes. Literature suggests faith has a significant impact upon these agencies. We outline very specific similarities and differences, highlighting the importance of nuanced analysis of faith's role in FBOs. Further research is needed to build more evidence around these impacts of faith on FBOs.     

Water tariff conflict resolution through indigenous participation in tri-water sector partnerships: Dalun cluster communities in northern Ghana

The paper examines how the perceived ownership of a water resource negatively influenced local people's attitudes towards payment of potable water tariffs and exacerbated conflicts between water users and service providers in the Dalun community of the northern region of Ghana. The paper presents a case study of how community participation and endogenous approaches to conflict resolution contributed to payment of water tariffs. The findings show that the establishment of a tri-water sector partnership (TWSP), consisting of the Ghana Water Company Ltd (GWCL), private sector development practitioners, and community water boards, led to positive mediation of water tariff conflicts using the institution of chieftaincy. Alternative, endogenous conflict resolution methods combined with modern methods in a tripartite partnership showed promise as an approach to managing conflicts in water projects and in broader poverty reduction efforts.     

Effects of neoliberal adjustments on government-funded international volunteer cooperation organisations

This paper uses findings from a survey of 19 government-funded international volunteer cooperation organisations (IVCOs) to discuss whether past and future patterns of government funding provide support for assertions of neoliberal adjustments. Findings indicate greater competition between providers, increased accountability for aid effectiveness, more private sector involvement, and an emphasis on domestic priorities with a focus on the skill-development of young volunteers. It provides examples of these changes and discusses the implications of changing patterns of government funding for international volunteering as an approach to development aid.

Effets des ajustements néolibéraux sur les organismes de coopération internationale bénévole financés par des gouvernements

Cet article se sert des résultats d'une enquête menée parmi 19 organismes de coopération internationale bénévole (OCIB) financés par des gouvernements pour discuter de la question de savoir si les schémas passés et futurs de financement gouvernemental viennent prouver les ajustements néolibéraux. Les résultats indiquent une concurrence accrue entre fournisseurs, une redevabilité accrue pour ce qui est de l'efficacité de l'aide, une participation plus importante du secteur privé, et un accent sur les priorités nationales, avec pour axe central le développement des compétences des jeunes bénévoles. Il donne des exemples de ces changements et traite des implications de l’évolution des schémas de financement gouvernemental pour le bénévolat international comme approche de l'aide au développement.

Efectos de los ajustes neoliberales en organizaciones internacionales de cooperación voluntaria financiadas por gobiernos

El presente artículo se apoya en una encuesta aplicada a 19 organizaciones internacionales de cooperación voluntaria (oicv) financiadas por gobiernos, realizada con el fin de polemizar respecto a si los actuales y los pasados patrones de financiamiento gubernamental sustentan las afirmaciones de [que se produjeron] ajustes neoliberales. Las conclusiones demuestran la existencia de mayor competencia entre proveedores, así como mayor rendición de cuentas en torno a la eficacia de la ayuda, más participación del sector privado y un énfasis en las prioridades nacionales, centrado en el desarrollo de habilidades en los jóvenes voluntarios. El artículo proporciona ejemplos de estos cambios y examina las implicaciones que los cambiantes patrones de financiamiento gubernamental tienen para el voluntariado internacional como enfoque para la ayuda de desarrollo.

Efeitos de ajustes neoliberais em Organizações Internacionais de Cooperação de Voluntários financiadas pelo governo

Este artigo utiliza resultados de uma pesquisa de 19 Organizações Internacionais de Cooperação de Voluntários (IVCOs) financiada pelo governo para discutir se padrões passados e futuros de financiamento governamental oferecem apoio para reivindicações de ajustes neoliberais. Os resultados indicam uma maior competição entre provedores, maior prestação de contas para a efetividade da ajuda, mais envolvimento do setor privado e ênfase nas prioridades domésticas com enfoque no desenvolvimento de habilidades de jovens voluntários. O artigo oferece exemplos destas mudanças e discute as implicações de padrões variáveis de financiamento governamental para o voluntariado internacional como abordagem para a ajuda ao desenvolvimento.     

Factors affecting access to primary health care services in Pakistan: a gender-based analysis

This article explores access to primary health care (PHC) services and associated factors in Pakistan. Data were collected from 302 respondents. The findings revealed that women accessed PHC services more than men due to their greater health needs. However, a large proportion of both genders did not access any PHC services. Besides general weaknesses, gender-related barriers were found in basic health unit locations, distance, transport, staff availability, income, service hours, and service organisation, confirming gender issues in access to PHC services. Policymakers are recommended to take measures to improve access to PHC services through the formulation of gender-responsive policies and strategies.     

Whole-person health and development: two South Indian initiatives

ABSTRACT

In responding to the 2016 reformulation of the United Nation’s Sustainable Development Goals, the development community’s efforts are focused on a sweep of initiatives aiming to promote whole-society, sustainable development. The ambition of the SDGs is inspiring, but also daunting, and does not always sit easily within national models of economic development. This viewpoint profiles two organisations in the south Indian state of Tamil Nadu, that have decades of experience in whole-person development among scheduled tribes and disability communities. Both organisations serve as timely examples of ongoing holistic, whole-person health and development in the context of new ideals and economic realities.     

Demands,responsibility, and influence in Malawi’s participatory agricultural extension services

Participatory governance offers the potential to deliver responsive and accountable services. This article tests this expectation by looking at how members of participatory extension platforms in Malawi understand the meaning of “demand-driven” services, and allocate responsibility and influence in service provision. Results show that most respondents agree on bottom-up extension services that respond to expressed farmers’ needs (86% of respondents), and assign responsibility and influence widely across state and non-state actors. While these findings suggest that these participatory mechanisms can promote responsiveness to farmers’ needs and accountability, they also point toward different governance challenges in extension services.     

Roles of religious actors in the West African Ebola response

ABSTRACT

More than 11,000 people died during the 2014–15 Ebola epidemic. It devastated the communities concerned and set back progress in building health systems and socio-economic development more broadly. Concentrated in three poor West African countries, Guinea, Liberia, and Sierra Leone, the tremors reverberated worldwide, spurring mobilisation of vast human and financial resources. The epidemic highlighted contemporary challenges for public health, particularly in fragile states, with lessons extending far beyond health sectors. Religious actors played distinctive roles at various points and across different sectors. This article focuses on religious responses to the 2014 Ebola epidemic and implications for public health practitioners.     

Faith and palliative care: a partnership of care in low- and middle-income countries

ABSTRACT

The provision of holistic palliative care has been identified by WHO as a human right, important for all people, at all ages, with all life-limiting illnesses. When faced with death and dying, issues of meaning and relationships with others, the world, and with the sacred are intensified even more in communities where faith and spiritual beliefs have a significant place. Being able to understand the significance of dying and interpreting the experience and period of living with life-limiting illness, presents an important challenge for palliative care. This article sets out the contribution that faith communities have made in understanding the significance of spiritual issues in health and in delivering palliative care in lower to middle-income contexts where palliative care has been prioritised.     

Food insecurity and ART adherence in Swaziland: the case for coordinated faith-based and multi-sectoral action

ABSTRACT

Faith-based organisations (FBOs) have long been involved in HIV and AIDS impact mitigation and humanitarian relief, but most are not equipped to intervene in the structural drivers of food insecurity and attendant health inequities. Acknowledging limitations is as paramount a task for organisational effectiveness as maximising strengths. This article reports findings from a study of HIV-positive care supporters who volunteer with a church-run home-based care organisation in Swaziland. The article seeks to assess the impact of chronic food insecurity on antiretroviral adherence practices and how these individuals manage daily food shortages. Findings highlight the limited capacities of FBOs in highly vulnerable settings and the imperative for international and governmental coordination.