The role of faith-based health providers in regions with fragile health systems

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Faith-based health providers (FBHP) play an essential role in health provision, particularly in fragile health systems

At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively.

Key messages • Increased attention has been paid to faith-based entities engaged in health from a policy level during the past decade • Little systematic and similar data is available relating to faith-based, non-profit health providers • Data from household surveys suggest lower market shares than commonly assumed, but higher levels of satisfaction than in public facilities • Faith-based health providers play an important part in many countries in Africa, particularly in fragile or weakened health systems • However, many faith-based health providers show signs of weakness and little ability to adapt to their changed health systems contexts and financial constraints • Appreciation of health providers’ contribution to health care is tempered by lingering controversies tied to faith-based social engagement (which are discussed in more detail in later parts of this Series) • Broad generalizations about faith-based organizations or the faith sector should be avoided • More detailed health systems research is necessary (e.g., research that unpacks how exactly faith-based health providers contribute [or don’t] to universal health coverage at a country level) • More detailed policy implementation strategies relating to faith-based providers are needed (e.g., specific strategies for improved public–private partnership with faith-based providers).

The main conclusion is that more and improved data are needed to provide support at management and policy levels on every aspect relating to how FBHPs routinely function within their health systems. We need to move away from broad generalizations of the magnitude and character of FBOs and instead find out how different kinds of FBHPs operate within different contexts and systems. Rather than relying on basic proxies, we need to understand in a more complex manner, the interactions of management practice, organizational culture, pharmaceutical supply, cost recovery, and human resource management, and how these affect (clinical) quality, satisfaction, and use, and then how this affects access, reaches to poor people, and broader goals such as universal health care

Olivier J, Tsimpo C, Gemignani R, et al. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. The Lancet. 2015;doi:10.1016/S0140-6736(15)60251-3.