PARTNERSHIP-BUILDING IN THE FAITH-HEALTH

LANDSCAPE

Aligning faith-inspired health providers in complex health systems

Dr. JILL OLIVIERUniversity of Cape Town, School of Public Health and Family Medicine,

Health Systems DivisionInternational Religious Health Assets Programme

www.irhap.uct.ac.za Jill.olivier@uct.ac.za

A rapid history of the ‘field’…Focusing on the ‘field’ at the intersection of faith-health-development… not purely academic… but a multidisc and multisectoral space

Not a new area of interest - some watershed times:

•1960s work of CMC (e.g. McGilvray 1981)… historically working in isolation, often unaligned with new national systems

•1990s, internat work on faith & development (e.g. Katherine et al)

"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" (Wolfensohn, WB, 2002)

•1990s-2000s: more focus on faith and public health

•1990s-2000s: public-private split, failure of secularisation thesis, HIV/AIDS, increased focus on ‘alignment’, ‘mapping’ and ‘marketshare’ obsession

A rapid history…

• Distinct areas of dialogue and study: Relig & spirituality, relig & behaviours, relig & development, relig & public health

• Large advocacy efforts…on whether FBOs were getting fair recognition from the international worked (and funding)… getting FBOs ‘on the map’ or ‘at the table’

• Lots of focus on the ‘comparative advantages’ & disadvantages:

• …unique reach, trust, access into communities, resources such as volunteers and community leadership, networks, means to motivate staff, provide quality ‘compassionate care’, in remote areas, reach to poor, user preference…

• …dogmatic resistance to change, unsustainable, poor documentation, poor management (‘hired because a good Christian’), lack of resources, competition…

A rapid history of the ‘field’ irt HIV/AIDS

• Early years of the pandemic: no comparative value… invisibility• A comparatively negative value… phases of “moral panic”……UNAIDS

1999 “greatest obstacle”…religionophobia…comparatively worse• (late 20thC) cautiously positive… relig re-emerges into public life and

scholarship, “The world today…is as furiously religious as it ever was, and in some places more so than ever” (Berger), culturally appropriate

• Comparatively conflicted: struggling to understand … new interest = opposing lists of strengths and weaknesses – any position is defensible:• E.g. ‘FBO’s are comparatively stronger/weaker than NGOs

• E.g. FBOs have unique assets/liabilities for intervention

• E.g. Religious leaders are a key tool / main obstacle to HIV prevention

• Current phase of push-back…advocacy and general statements have less weight, funding constraints, demands for more ‘real secular evidence’, loss of patience with dialogue… the search for new ideas

Currently: a massive ‘field’ with silos

Little for evidence-based policy and decision-making

•Massive evidence gaps…(e.g. 30-70% estimate)

•Especially at the informal, community level

•Mainly focused on mainstream-Anglophone-Africa (some on US and India)…and mainly around HIV/AIDS response

Silos of interests, and silos of interested groups•Historical reasons for not collaborating or remaining ‘off the map’•Networks: ACHAP, AHN, ADN, Anerela, ARHAP/IRHAP, CCIH, CHART, EAA, FBHLG, JLI-LFC, UN-interagency group…etc etc•Orgs that network: AKDN, CAFOD, CIFA, Christian Aid, CORDAID, CRS, Difaem, ICCO, Islamic Relief, TSA, TBFF, Tearfund, WFDD, WV, (CHAs, all the denominational groups) …etc•Universities that network: BU, Emory, Georgetown, UCT, UKZN…etc

Currently: competing discourses and agendas• Different languages… ‘like ships passing in the night’ (KMarshall)• How do you put an epidemiologist, a theologian, an NGO manager, a

policy-maker and a local religious leader in a room together…• …evidence through different disciplinary frameworks, with different

languages, typologies, lenses and agendas

• e.g. lack of basic consensus on the ‘unit’ of analysis… there is no common typology for ‘FBO’• E.g. “All organisations in Uganda are FBOs!”• the basic religious-secular divide is problematic in itself…there is no

‘faith sector’… and ‘FBOs’ tend to fall in the grey areas

My top issues:• Context and complexity is unavoidable and must be dealt with

• Faith-inspired initiatives (FIIs) continue to be unaligned with national responses

• We need to continue to ‘map’ FIIs…all the way down to the messy community and non-mainstream level

• The time for listing generalized comparative advantages/ disadvantages of ‘FBO’s as an advocacy tool has passed (they now do more damage than good)

• We need evidence-based analysis of specific ‘differences’

• Broad-scale research that draws on quantitative and technical analysis is urgent … equally urgent is nuanced case-study research that takes context into account

e.g. Specific questions being asked now

• Faith-sensitive indicators of impact or change… and standardized measurement tools and processes

• Best practices for engagement with local faith communities

• Community held assets (religious health assets) and systems (CSS)

• Specific program or disease areas: e.g. best practices for strengthening immunization, resilience, MCH, HIV/AIDS

• Intangibles or values: volunteerism, compassionate care, good governance, trust, motivation,

• Beyond market share: to innovations, mechanisms, performance, quality, impact on most vulnerable, reach to the poor (e.g. Robin Hood), justice, access, sustainability, resilience…etc

• Governance, leadership capacity and religious literacy

The widest ‘open door’ is ‘health systems’• Health Policy and Systems Research an emerging field

• Embraces context and complexity

• Necessitates understanding FIIs as part of the system

• Embraces multiple perspectives:

• Interdisciplinary, includes social science, bridges community-provider divide and practice-research divide

• Bridges development and public health

• Software of the health system is as important as the hardware (e.g. people, values, perceptions, trust etc)

-end-• See www.irhap.uct.ac.za – other partner resources there

• See “Strengthening the Evidence for Faith-inspired Health Engagement in Africa, Volume 1, 2 & 3” http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/0,,contentMDK:20131121~menuPK:578586~pagePK:148956~piPK:216618~theSitePK:282511,00.html

Rodriguez-Garcia et al. 2011

FBOs…Eg: church, congregation, religious community, faith-based

institution, faith-based organisation, faith-based group, faith-related organizations, faith-background organizations, faith-centered organizations, faith-saturated organizations, faith-inspired organization, religious organization, religious-based organization, religious group, religious facility, religious institution, community-based organisation, church-based organisation, facility based religious entity, non-facility based religious entity, women’s groups, youth groups, faith-inspired network, national faith-based health network, faith-based networks, umbrella group, religious umbrella body … and many many more…

‘Mapping the Mapping’ of Faith-inspired Health Initiatives

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e.g. Poverty Mappinge.g. World Bank, Poverty Mapping (Coulombe & Wodon, 2011)

e.g. MLH, Memphis

Health systems are dynamic & interconnected systems at whose heart are people (see Gilson 2012, Alliance Reader)

Recognising complexity

Source,: Dimmock, Olivier, Wodon, 2012