1. 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)

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

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

4. Learning more about (biomedical) FB health providers in Africa

5. 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

6. 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

7. 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

8. Emerging evidence on faith-community response to HIV and AIDS

9. 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

10. 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

11. Dr. Jill Olivier This presentation draws on:
University of Cape Town, School of Public Health and Family Medicine,
Health Policy and Systems Division
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 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):
Olivier J & Smith S Innovative faith-community responses to HIV and AIDS: Summative lessons from over two decades of work. Review of Faith and International Affairs 14(3).