CHRISTIAN HEALTH ASSOCIATIONS IN AFRICA Presented at CCIH Annual Conference May 29, 2005 Frank E. Dimmock P.O. Box 1266, Lilongwe MALAWI

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CHRISTIAN HEALTH ASSOCIATIONS IN AFRICA Presented at CCIH Annual Conference May 29, 2005 Frank E. Dimmock P.O. Box 1266, Lilongwe MALAWI

Countries with CHAs - 12 Lesotho – CHAL Zimbabwe – ZACH Zambia – CHAZ Malawi – CHAM Tanzania – CSSC Kenya – CHAK & KEC Uganda – UPMB, UCMB Sudan - CHAS Nigeria - CHAN Ghana – CHAG Liberia – CHAL Sierra Leone - CHASL

Characteristics of the Associations: Southern Africa LESOTHO – founded in 1974, 8 hospitals & 75 HCs, ~40% of NHS, decentralised in 1984 to HSAs, formal agreement w/ GoL in 1991, Professional staff salaries + 20% operating budget/yr from GoL. Currently being restructured to District level. All health facilities digitally mapped.

ZAMBIA – founded in 1970, 30 Hospitals & 60+ HCs, ~ 30% of NHS, Professional staff paid by GRZ, MoU signed in 1996, Church Hospitals given 75% operating budget, decentralised to District Health Boards, CHAZ now includes non-institutional members. Mapping of facilities in process (05/05) ZIMBABWE – founded in 1974, 52 hospitals & 68 HCs, ~45% of NHS, 8 DDH, fees set by Gvt., Gvt. Grant reduced by revenue amt., Gvt supports training schools.

MALAWI – founded in 1966, 28 Hospitals & 125 HCs, ~ 37% of NHS, MoU signed in 2002, All established positions reimbursed by GoM, Decentralisation now w/ district-level service agreements. All Health facilities digitally mapped.

CHA features cont’d East Africa TANZANIA – founded in 1992, 81 Hospitals + 2 TH, 68 HCs, 21 DDH w/ 100% op expenses covered by Gvt., ~ 48% NHS, Block grants to Church hospitals, service agreements in prep. KENYA – founded as CHAK in 1982, 24 Hospitals,43 HCs, 298 disp., 51 Church Health Progs., ~40% NHS, restructured in ’97, Area Coord. Cttees., new CHAK-GoK TWG formed, no gvt. grants rec’d since Digital mapping of Health facilities in process KEC = Catholic Health Association

UGANDA – UPMB – founded in 1955, 17 Hospitals, 115 HCs, ~20% NHS, annual service-level district level, Gvt. seconded staff. - UCMB - founded in 1955, 27 Hospitals, 232 HCs, ~32% NHS, Gvt. supports ~ 30% operating expenses, PPPH office assists in collaboration w/ Gvt. PNfP providers CR from fees = 43%. ~ 30% from gvt support. Service contracts since PPPH office established to enhance collaboration. Digital mapping of all Health Services in process

SUDAN – CHAS Founded on Friday, May 6, Lead Agency in the formation is CEAS (Churches Ecumenical Action Sudan) Currently 4 general hospitals, 30 specialist hospitals, 5 training schools mostly managed by IFBOs ~30% HS provided by Christian INGOs & Sudan Churches

Features cont’d West Africa NIGERIA - CHAN GHANA – CHAG Founded in 1967, ~ 34% NHS, Developed QA & Accreditation system SIERRA LEONE - CHASL LIBERIA – CHAL Founded in 1975, 5 Hosp, 67 HCs, ~47% NHS, collab w/ MoH/SW in CBR, WASH, FLE, PSS.. Little institutional support

Central African Republic Rwanda Togo APROMESTO ASSOMESCA BUFMAR

Other Countries with Networks or Coordinating Agencies: Ethiopia CRDA Botswana AMMB Angola CICA Democratic Republic of Congo SANRU ~ 50% NHS by FBOs Senegal EPSCM Namibia NCC Cameroon FEMEC

Summary Characteristics of Associations History of health networking (CMC of WCC established in 1968) Members provide significant portion of National H.S. & training of Health personnel Formal agreement / MoU with Government & service District level Participate in National Health Planning & Policy setting Have implemented and facilitated health programmes Most related w/ WCC, EPN, and other international bodies

Core Functions of CHAs  Advocacy (Planning & Policy Setting)  Technical Assistance & Training (constructive encouragement)  Capacity building / Institutional strengthening (SP, OD, HR)  Resource Mobilisation / Administration (facilitate partnerships)  Research (ARHAP, HIV/AIDS)  Monitoring & Evaluation (establishing standards)  Joint procurement (MEDS, JMS) & equipment maintenance  Communication, Health Information

Government Donors Association Member Health Church Units/Programmes Leaders

Challenges of Christian Health Associations: Mandate / Authority (advisory vs control) Financial Sustainability Membership – composition & accountability Diversity of membership (capacity variance) Relationship balance (with 4 corners) Communication (external and internal) Coverage (Geographic and programme) Leadership (turnover and commitment) Publicity (profile & evidence)