The roles of faith-based health-care providers (in Africa) Persistently problematic data gaps "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" (James Wolfensohn, WB, 2002)

Overview of Evidence: Quantity and Quality 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

Overview of Evidence: 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

Learning more about (biomedical) FB health providers in Africa

Estimates of market share of FBNPs vs public health system Country Self-declared share (beds) hospitals Health Centers Training facilities Benin 40% 6 20 28 Botswana 18% 2 Cameroon 30 150 3 CAR 20% 62 19 Chad 4 164 DRC 50% 89 600 Ghana 42% 58 104 10 Kenya 74 808 24 Lesotho 8 72 Liberia 10% 67 Malawi 37% 27 142 Nigeria 147 2747 Tanzania 815 Togo 39 Uganda 47 541 Zambia 36 110 9 Zimbabwe 35% 80 46 15 Estimates of market share of FBNPs vs public health system Note: based on hospital beds and facilities Note: e.g. of African countries with more substantial share

More important to look at: Access, utilization, cost, satisfaction, reach to poor etc… 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 Not about exceptionalism – but integrated systems

Community response to HIV and AIDS A Fast Track Approach calls for accelerated, more equitable and strategic delivery of services, along with advances on human rights issues. Scaling up community responses to HIV is integral to this approach. Several robust studies show that community-based services can be cost-effective, efficient, and can fill gaps through improved linkages and synergies (UNAIDS & MSF 2015, Rodriguez-Garcia et al 2013, Birdsall & Kelly 2007, UNAIDS 2015) Source: UNAIDS 2015

Emerging evidence on faith-community response to HIV and AIDS

Egs of faith-community response across all types / levels   Description Type Households, extended families, & neighbors assisting each other Food, child care, household chores, or home-based care Community leadership Political, religious or traditional leaders Community initiatives Mutual care and support groups, neighborhood associations, savings clubs, counselling groups, support mechanisms, voluntary labor, and self-help groups Community-based organizations Community associations, congregations Nongovernmental organizations & networks (local/nat/internat) FBOs, intermediaries, national networks, multisectoral collaborative platforms, district level HIV/AIDS task forces, local leadership councils Rights-based organizations & social movements Advocacy movements Mass organizations Community branches of women’s or youth organizations, national networks of PLHIV Private sector organizations Local businesses, local foundations Systems of service providers Provision of health, education or development Governance structures Government staff and agencies, faith-based denominational bodies MOST FORMAL MOST INFORMAL Source: Original schema by Rodriguez-Garcia et al (2011), adapted here by Olivier & Smith

Evidence on faith-community response Faith communities have responded to HIV and AIDS—across all service areas, and in a wild variety of ways that adds to global response Faith communities respond in some areas more easily than in others, and sometimes that response does not match international strategy Exemplary response is that which finds a balance between (standard) ‘good operational practices’, ‘good public health’, and ‘good theology’ More research on faith-community response is needed—ranging from comparative assessments of effectiveness and impact, to participatory and suitable assessment of local community response There are no easy answers for policy-planners, and faith communities are complex. But variation and complexity can be an asset, opening spaces for innovative and culturally appropriate approaches Imperative to draw lessons/evidence from HIV/AIDS into other concerns

Dr. Jill Olivier This presentation draws on: University of Cape Town, School of Public Health and Family Medicine, Health Policy and Systems Division Jill.olivier@uct.ac.za This presentation draws on: Olivier J, Tsimpo C, Gemignani R, Shojo M, Coulombe H, Dimmock F, Nguyen MC, Hines H, Mills EJ, Dieleman JL, Haakenstad A and Wodon Q. 2015. Understanding the significance of faith-based healthcare providers in Africa: a review of the evidence with a focus on magnitude, reach, cost, and satisfaction. The Lancet 386(10005): 1765-1775. Olivier J & Smith S. 2016. Innovative faith-community responses to HIV and AIDS: Summative lessons from over two decades of work. Review of Faith and International Affairs 14(3).