Perceptions and expectations

Research under Stakeholders of Christian Health Agencies

Christina de Vries & 4-country team.

Four country studies

• CHAZ Zambia Chiku

• CHAK Kenia Masheti

• UCMB / UPMB Uganda Ssengooba

• CHAG Ghana Cleo Gayi

Contribution of Christian Health Networks to the National Health Sector in Select African Countries

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10

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40

50

60

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Liber

ia

Ghana

DRCongo

South

Sud

an

Kenya

Ugand

a

Tanza

nia

Mal

awi

Zambia

Zimba

bwe

Leso

tho

Fa

cili

tie

s

FBO MoH

Study questions

1. Main strategic objectives of the CHAs and their members to work with the Icco Alliance and Cordaid and vice versa ?

2 What can be the role of CHAs and their members to improve access to PHC for marginalized groups ?

3. What can be the added value of ACHAP for the CHAs and their members ?

Perspectives from Icco and Cordaid (1)

• Changing context

• Changing funding arrangements

• Changing theories-of-change

Synergy donor – CHA policies ?

Objectives intrinsic to

- Dutch donor- the CHA network and

of benefit to the members

- worth supporting ?

Objectives identified for partnerships and external support

• Programs• Alliances• Complementing

government health services

• HRH development

Perspectives icco and cordaid (2)

Limitations CHAs:

- Management and governance capacity

- Doubts about representation & ownership

- Doubts about influence circles,- Icco and Cordaid little influence on CHAs.

Governance

• Representation– membership– network arrangements– transparency and credibility

• Participation– capacity

• Quality of network support– responsiveness

• Expectations

Perspective CHIs towards CHAs

results (1)

• CHAs different history, different contexts, different mandates

• CHAs similar network challenges, similar funding challenges, more uniformity in public-private relations

results community level stakeholders (2)

• Sharp criticism from community levels to northern agencies: call for solidarity and commitment particularly in times of crisis !

• FBO health care much needed in rural settings• Advocacy for health needs more linking of

grassroots and national fora:– Empowement of VHCs, participation in governance

and planning– Dat collection, PME to be improved (ICT ?)

Minga High School

Chipembe Stores

Menyani Rural Health Center

Nkopeka Rural Health Center (Nyimba District)

Menwe Rural Health Center

Mumbi Rural Health Center

Mwanja Bantu Rural Health Center

Minga Mission Hospital

Minga Stop NBH Committee

Bangwe NBH Committee

Kasusu NBH Committee

Mangomba NBH Committee – 12Kms from Hosp.

Kanjoka NBH Committee– 14Kms from Hosp.

Nyika NBHMvuvye NBH Committee

Chitiwi NBH

Mulira NBH

Lwezi NBHChimate, Kaluba, Kasondo, Mwambezi,NBH’s

Nyamatepo NBH

Njeemi NBH

Malowe NBH

Medical Referrals

AR

T

ART

ART

AR

T

ART

Medical Referrals

Medical Referrals

Minga Mission provides Medical

and ART support… all NBH

CommitteesMinga Mission provides

ART Services and Additional HR through

Community Health Workers (CHWs) … all Rural Health Centers

(RHCs)

•Training of CHWs & Posting to all RHCs.•Client Feedback through NBH•RHCs Partners in delivering Health Services

•Training of CHWs & Posting to all RHCs.•Client Feedback through NBH•RHCs Partners in delivering Health Services

Great East Road

Catchment Population: 22,650

Minga Mission Hospital and Interactions with the Community in Petauke District

results (3)

• Representation and participation: contradictory views

• Monitoring and information management,– Needs innovation

• Shortage of health personnel, more management demands not the solution.

results (4)

• Larger member institutions benefit relatively more from CHA resources than smaller ones; also true for CHAs within ACHAP or GF access

results (5)

Relation with the governmental health sector:

• MOUs and contracts

• Dependency

• Complementarity

• Compliance and harmonisation with MoH

• Some advocacy on behalf of members, little on behalf of healthcare users

results (6)

Diversification of funding sources, funding tracks and funding requirements:

- Rights-based, empowerment- Post-conflict- Performance-based orientation- Resource tracking right down to the

beneficiaries- Shift from system support to program

support

results (7)

Advocacy:

- Confused and diffuse concepts

- Shift target from MoH to MoF

- Alliance-building, input-result difficult to assess

- Constituency-base is an asset

- Capacity is a challenge, funding ?

- CHAs and Church

The renewed definition of PHCThe renewed definition of PHCFocusing on the health system as a Focusing on the health system as a

wholewhole

• Include public, private, and non-profit sectorsInclude public, private, and non-profit sectors

• Recognize PHC as more than provision of health services:Recognize PHC as more than provision of health services:

• Differentiate values, principles and elementsDifferentiate values, principles and elements

• Highlight equity and solidarity;Highlight equity and solidarity;

• Incorporate sustainability and a quality orientation. Incorporate sustainability and a quality orientation.

• Specify measurable organizational & functional elements Specify measurable organizational & functional elements

• Recognize dependency on other health system & social processes Recognize dependency on other health system & social processes

• Recognize need for each country to design their own strategyRecognize need for each country to design their own strategy

Recommendations

• Support to CHA as a health system• More guidance in shift towards

programmatic approach; serious attention for adverse effects

• More attention for advocacy and lobby: capacity, multi-level system and agenda.

• Recognition and positioning of CHAs as major actors.

• Role for ACHAP.

Thank you.