1. Perceptions and expectations Research under Stakeholders of Christian Health Agencies Christina de Vries & 4-country team.

2. Four country studies CHAZ ZambiaChiku CHAK KeniaMasheti UCMB / UPMB Uganda Ssengooba CHAG GhanaCleo Gayi

4. 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 ?

5. Perspectives from Icco and Cordaid (1) Changing context Changing funding arrangements Changing theories-of-change

7. 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

8. 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.

9. Governance Representation – membership – network arrangements – transparency and credibility Participation – capacity Quality of network support –responsiveness Expectations

10. Perspective CHIs towards CHAs

11. results (1) CHAs different history, different contexts, different mandates CHAs similar network challenges, similar funding challenges, more uniformity in public-private relations

12. 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 ?)

13. 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 NBH Mvuvye NBH Committee Chitiwi NBH Mulira NBH Lwezi NBH Chimate, Kaluba, Kasondo, Mwambezi,N BH’s Nyamatepo NBH Njeemi NBH Malowe NBH Medical Referrals ARTART ARTART ARTART ARTART ARTART Minga Mission provides Medical and ART support… all NBH Committees Minga 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

14. results (3) Representation and participation: contradictory views Monitoring and information management, –Needs innovation Shortage of health personnel, more management demands not the solution.

15. results (4) Larger member institutions benefit relatively more from CHA resources than smaller ones; also true for CHAs within ACHAP or GF access

16. 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

17. 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

18. 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

19. The renewed definition of PHC Focusing on the health system as a whole 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 elementsSpecify measurable organizational & functional elements Recognize dependency on other health system & social processesRecognize 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

20. 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.

21. Thank you.