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 percentage of HIV treatment and prevention services in Kenya provided by faith-based health providers

ABSTRACT

Although the percentage of health services provided by the faith-based sector in sub-Saharan Africa is often cited along a range from 30% to 70%, depending on the country, such citations tend to be anecdotal and without reference to actual analysis of health service data. This article reports on a secondary analysis of health service data in Kenya to determine the percentage of HIV services provided by faith-based health providers. It then discusses the contributions of faith-based providers in light of these data, identifying opportunities and challenges involved in efforts to ensure that the resources of the faith-based sector are maximised.     

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.     

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.     

A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

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.     

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.     

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.     

Reaching beyond the health post: Community-based surveillance for polio eradication

This article discusses the CORE Group Polio Project Ethiopia's introduction of community-based surveillance (CBS) of acute flaccid paralysis (AFP) to support polio eradication. A USAID-funded collaboration among Ethiopian and US-based NGOs, the CGPP supports volunteers in education about AFP and encouraging case reporting. Volunteers also conduct active case searches, visiting community leaders likely to have contact with paralysis cases. The project's methods strengthen communities' awareness of AFP and their connection to the health system. Data indicate a near doubling of AFP reporting in project areas since the implementation of CBS, according to MOH-E (Ministry of Health, Ethiopia)/WHO statistics.

Allant au-delà du poste de santé: surveillance communautaire pour éradication de la poliomyélite

Cet article traite de l'introduction par le Projet sur la polio du CORE Group (CGPP) en Éthiopie de la surveillance communautaire (SC) de la paralysie flasque aiguë (PFA) pour soutenir l’éradication de la polio. Le CGPP, collaboration financée par USAID entre ONG éthiopiennes et basées aux États-Unis, aide des volontaires à mener une éducation sur la PFA et à encourager la notification des cas. Les volontaires effectuent aussi des recherches actives de cas, rendant visite aux leaders communautaires susceptibles d’être en contact avec des cas de paralysie. Les méthodes du projet renforcent la prise de conscience par les communautés de la PFA et leurs liens avec le système de santé. Les données indiquent que le nombre de cas de PFA signalés a presque doublé dans les zones du projet depuis la mise en ?uvre de la SC, d'après les statistiques du Ministère de la Santé, éthiopien et de l'OMS.

Llegar más allá del puesto de salud: vigilancia comunitaria para erradicación de la poliomielitis

Este artículo examina el Proyecto contra la Poliomielitis llevado a cabo en Etiopía por CORE Group (CGPP por sus siglas en inglés), así como el uso que realiza del método de vigilancia comunitaria (VC) para el seguimiento de la parálisis flácida aguda (PFA). El objetivo de este proyecto es erradicar la polio. Constituye un esfuerzo conjunto de ONG etíopes y estadounidenses, financiado por USAID. CGPP apoya la formación de voluntarios para la vigilancia de la PFA, promoviendo la elaboración de informes sobre distintos casos. Asimismo, los voluntarios dan seguimiento a los casos vigentes, realizando visitas a los líderes comunitarios que, con frecuencia, tienen contacto con personas con parálisis. La metodología del proyecto impulsa la conciencia comunitaria en relación a la PFA y al vínculo entre las comunidades y el sistema de salud. Las estadísticas reportadas por el Ministerio de Salud de Etiopía y la OMS indican que, desde que inició la VC, se han duplicado los informes sobre PFA en las áreas abarcadas por el proyecto.

Indo além do posto de saúde: investigação baseada na comunidade para a erradicação da polio

Este artigo discute a introdução da Investigação Baseada na Comunidade sobre casos de paralisia flácida aguda (AFP) do Projeto Pólio do Grupo CORE da Etiópia, voltada para apoiar a erradicação da pólio. Uma colaboração financiada pela USAID entre ONGs baseadas na Etiópia e EUA, o CGPP apóia voluntários na educação sobre AFP e incentiva o relato de casos. Os voluntários também conduzem pesquisas de caso ativas, visitando líderes de comunidade que provavelmente tenham contato com casos de paralisia. Os métodos do projeto fortalecem a conscientização das comunidades a respeito da AFP e sua conexão com o sistema de saúde. Os dados indicam que o número de relatos de AFP nas áreas do projeto quase dobrou desde a Implementação da Investigação Baseada na Comunidade, de acordo com estatísticas da MOH-E/WHO.     

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.     

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.     

“They don't garden here”: NGO constructions of Maya gardening practices in Belize

Communities in southern Belize have among the poorest health outcomes in the region, including high rates of under-nutrition. In response, an NGO school garden programme has been initiated to improve health and nutrition. An analysis of the programme as it relates to home garden practices and diet in two Q'eqchi' Maya communities illustrates the complexity of challenges faced by NGOs. Most notable are issues of legitimacy, cultural appropriateness, self-interest, and constructed conceptions of their target communities, all of which raise the question of what is more important: autonomous and healthy communities or the preservation of the NGO programme?

« Ils ne font pas de jardinage, ici » : constructions d'une ONG des pratiques de jardinage mayas au Belize

Les communautés du sud du Belize affichent certains des pires résultats de la région en matière de santé, y compris un taux élevé de sous-nutrition. Pour remédier à cette situation, un programme de potagers scolaires mené par une ONG a été lancé pour améliorer la santé et la nutrition. Une analyse du programme du point de vue de ses liens avec les pratiques de culture de potagers familiaux et le régime de deux communautés mayas Q'eqchi’ illustre la complexité des défis auxquels sont confrontés les ONG. Les questions les plus notables sont celles de la légitimité, du caractère approprié sur le plan culturel, de l'intérêt propre, et des conceptions construites de leurs communautés cibles, autant de questions qui soulèvent celle de savoir ce qui est plus important : des communautés autonomes et en bonne santé ou la préservation du programme de l'ONG?

“Aquí no realizan jardinería”: construcciones de ong en torno a las prácticas de jardinería de los indígenas mayas de Belice

Las comunidades del sur de Belice muestran algunos de los peores resultados de salud en la región, entre los que se incluye una alta tasa de desnutrición. Con el objetivo de mejorar la salud y de combatir la desnutrición, varias ong impulsaron un programa de jardines escolares. Una evaluación del programa en torno a las prácticas de jardinería en el hogar y a la dieta de dos comunidades maya q'eqchi’, ilustra la complejidad de los retos enfrentados por las ong. Entre los más destacados se encuentran temas de legitimidad, de idoneidad cultural, de interés egoísta y de conceptos construidos por las ong respecto a sus comunidades destinatarias. Estos retos provocan la reflexión en relación a si es preferible tener comunidades autónomas y sanas o conservar programas de ong.

“Eles não cultivam hortas aqui”: promoção de práticas maias de jardinagem por uma ONG em Belize

Comunidades do sul de Belize estão entre as que possuem os mais baixos indicadores de saúde da região, incluindo altas taxas de desnutrição. Em resposta ao problema, um programa de horta escolar de uma ONG foi criado para melhorar a saúde e nutrição. Uma análise do programa no que se refere a práticas de cultivo de horta doméstica e dieta em duas comunidades maias de Q'eqchi ilustra a complexidade dos desafios enfrentados pelas ONGs. Os pontos que mais chamam atenção são as questões de legitimidade, adequação cultural, interesse próprio e concepções construídas sobre suas comunidades-alvo. Tudo isso suscita a questão sobre o que é mais importante: comunidades autônomas e saudáveis ou a preservação do programa de ONG?     

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.     

Practice-based insights in developing and implementing a sport-based programme for girls

Parivartan Plus is a structured sports mentoring programme for girls, implemented in a Mumbai slum where social expectations around gender-appropriate behaviour and good parenting restricts girls’ mobility and visibility in public spaces. This article presents practice-based learning from developing and implementing programme theory to empower girls in achieving changes in their everyday social interactions at home and beyond. Gender and social norms theory were combined with local practical wisdom to turn main implementation challenges into opportunities. The article reflects on the strategies that gave visibility to, and achieved community endorsement for, the erosion of restrictive gender norms while ensuring community safety.     

Community health workers – motivation and incentives

The Community Health Worker (CHW) literature is expansive, covering more than 30 years of interest in the concept. Despite this, understanding of CHW motivation and the effectiveness of monetary incentives is limited. Using self-determination theory (SDT) as an explanatory framework, the article outlines some of the roles and functions that CHWs have filled within health and community systems, CHW motivation, and how different factors either enhance or detract from this.

Agents de santé communautaires – motivation et incitations

Les documents portant sur les agents de santé communautaires (ASC) sont nombreux et couvrent plus de 30 ans d'intérêt dans ce concept. En dépit de cela, la compréhension de la motivation des ASC et de l'efficacité des incitations monétaires est limitée. En utilisant la théorie de l'autodétermination (TAD) comme cadre explicatif, cet article présente quelques-uns des rôles et des fonctions que les ASC ont remplis dans le cadre de systèmes sanitaires et communautaires, la motivation des ASC et la manière dont différents facteurs soit la renforcent soit l'affaiblissent.

Trabajadores de salud comunitarios - motivación e incentivos

Existen numerosas investigaciones sobre los trabajadores de salud comunitarios (tsc), que abarcan los más de 30 años durante los cuales el concepto ha sido objeto de estudio. A pesar de lo anterior, las motivaciones de los tsc y la eficacia de los incentivos monetarios no son ampliamente comprendidas. Con el apoyo de la teoría de la autodeterminación como marco analítico, el presente artículo expone algunos de los roles y de las funciones desempeñados por los tsc en los sistemas de salud comunitarios, así como las motivaciones que los impulsan, analizando, a la vez, los distintos factores que alientan o desincentivan tales motivaciones.

Trabalhadores comunitários da saúde – motivação e incentivos

A literatura sobre Trabalhadores Comunitários da Saúde (TCSs) é extensa, abrangendo mais de 30 anos de interesse no conceito. Apesar disto, o entendimento sobre a motivação dos TCSs e da efetividade de incentivos monetários é limitado. Utilizando a Teoria da Auto-Determinação (TAD) como estrutura explicativa, o artigo apresenta algumas das tarefas e funções que os TCSs têm realizado dentro dos sistemas de saúde e comunidade, a motivação dos TCSs e como fatores diferentes melhoram ou agravam a partir disto.     

The North Carolina Way: emerging healthcare system and faith community partnerships

ABSTRACT

United States healthcare policy has promoted the development of healthcare systems and community partnerships designed to decrease costs and readmissions, particularly for under-served populations. Typically, these partnerships are “hospital-centric”, focused on following in-house clinical costs into the community. Two contrasting large-scale community system models show results from development practices, integrating faith community partnerships that affect healthcare utilisation. This “community to hospital” focus is key to several such initiatives in the US. This article describes local implementation efforts in North Carolina, known as “the North Carolina Way”, and tests assumptions on implementation practices for creating robust faith-community and healthcare partnerships.     

Community grain banks and food security of the tribal poor in India

Given the context of failure of many of the programmes aimed at providing food security for tribal communities, this paper deals with the question, can grassroots-level experiments like community grain banks provide food security for the tribal poor? This paper examines the working of community grain banks established by Bapuji Rural Development and Enlightenment Society (BREDS) in India and concludes that community food grain banks demonstrate as an effective mechanism to ensure food security for the tribal poor, especially those who were excluded from the reach of government programmes.

Banques de céréales communautés et sécurité alimentaire des pauvres tribaux en Inde

Étant donné le contexte d’échec de nombre des programmes visant à assurer la sécurité alimentaire des communautés tribales, cet article traite de la question suivante : les expériences au niveau de la base populaire comme les banques de céréales communautaires peuvent-elles assurer la sécurité alimentaire des pauvres tribaux ? Cet article examine le fonctionnement des banques de céréales communautaires établies par la Bapuji Rural Development and Enlightenment Society (BREDS) en Inde et conclut que les banques de céréales alimentaires se révèlent être un mécanisme efficace pour garantir la sécurité alimentaire des pauvres tribaux, en particulier ceux qui ont été exclus de la portée des programmes gouvernementaux.

Bancos comunitarios de granos y seguridad alimentaria de las etnias pobres de India

Tomando en cuenta el contexto de fracaso de muchos programas dirigidos a proporcionar seguridad alimentaria a las comunidades étnicas, el presente artículo plantea la interrogante en torno a si experimentos realizados a nivel de base, como los bancos comunitarios de granos, ofrecen seguridad alimentaria a las etnias pobres. En este sentido, el artículo examina el desarrollo de los bancos comunitarios de granos establecidos por la Sociedad para el Desarrollo y la Iluminación Rural de Bapuji (breds) en India. Las conclusiones indican que dichos bancos constituyen un mecanismo efectivo para garantizar la seguridad alimentaria de las etnias pobres, especialmente de aquellas que habían sido excluidas del alcance de los programas gubernamentales.

Bancos comunitários de grãos e segurança alimentar de comunidades tribais pobres na Índia

Dado o contexto do fracasso de muitos dos programas destinados a oferecer segurança alimentar para as comunidades tribais, este artigo lida com a seguinte questão: experimentos de base, como os bancos comunitários de grãos, fornecem segurança alimentar para as comunidades tribais pobres? Este artigo examina o funcionamento de bancos comunitários de grãos criados pela Bapuji Rural Development and Enlightenment Society (BREDS) na Índia e conclui que os bancos comunitários de grãos de alimentos mostram ser um mecanismo eficiente para garantir a segurança alimentar para as comunidades tribais pobres, especialmente para aquelas que estavam fora do alcance de programas governamentais.