PARTNERSHIP-BUILDING IN THE FAITH-HEALTH LANDSCAPE

1. PARTNERSHIP-BUILDING IN THE FAITH-HEALTH LANDSCAPE Aligning faith-inspired health providers in complex health systems Dr. JILL OLIVIER University of Cape Town, School of Public Health and Family Medicine, Health Systems Division International Religious Health Assets Programme www.irhap.uct.ac.za Jill.olivier@uct.ac.za

2. A rapid history of the ‘field’… Focusing on the ‘field’ at the intersection of faith-health-development… not purely academic… but a multidisc and multisectoral space Not a new area of interest - some watershed times: • 1960s work of CMC (e.g. McGilvray 1981)… historically working in isolation, often unaligned with new national systems • 1990s, internat work on faith & development (e.g. Katherine et al) "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" (Wolfensohn, WB, 2002) • 1990s-2000s: more focus on faith and public health • 1990s-2000s: public-private split, failure of secularisation thesis, HIV/AIDS, increased focus on ‘alignment’, ‘mapping’ and ‘marketshare’ obsession

3. A rapid history… • Distinct areas of dialogue and study: Relig & spirituality, relig & behaviours, relig & development, relig & public health • Large advocacy efforts…on whether FBOs were getting fair recognition from the international worked (and funding)… getting FBOs ‘on the map’ or ‘at the table’ • Lots of focus on the ‘comparative advantages’ & disadvantages: • …unique reach, trust, access into communities, resources such as volunteers and community leadership, networks, means to motivate staff, provide quality ‘compassionate care’, in remote areas, reach to poor, user preference… • …dogmatic resistance to change, unsustainable, poor documentation, poor management (‘hired because a good Christian’), lack of resources, competition…

4. A rapid history of the ‘field’ irt HIV/AIDS • Early years of the pandemic: no comparative value… invisibility • A comparatively negative value… phases of “moral panic”……UNAIDS 1999 “greatest obstacle”…religionophobia…comparatively worse • (late 20thC) cautiously positive… relig re-emerges into public life and scholarship, “The world today…is as furiously religious as it ever was, and in some places more so than ever” (Berger), culturally appropriate • Comparatively conflicted: struggling to understand … new interest = opposing lists of strengths and weaknesses – any position is defensible: • E.g. ‘FBO’s are comparatively stronger/weaker than NGOs • E.g. FBOs have unique assets/liabilities for intervention • E.g. Religious leaders are a key tool / main obstacle to HIV prevention • Current phase of push-back…advocacy and general statements have less weight, funding constraints, demands for more ‘real secular evidence’, loss of patience with dialogue… the search for new ideas

5. Currently: a massive ‘field’ with silos Little for evidence-based policy and decision-making • Massive evidence gaps…(e.g. 30-70% estimate) • Especially at the informal, community level • Mainly focused on mainstream-Anglophone-Africa (some on US and India)…and mainly around HIV/AIDS response Silos of interests, and silos of interested groups • Historical reasons for not collaborating or remaining ‘off the map’ • Networks: ACHAP, AHN, ADN, Anerela, ARHAP/IRHAP, CCIH, CHART, EAA, FBHLG, JLI-LFC, UN-interagency group…etcetc • Orgs that network: AKDN, CAFOD, CIFA, Christian Aid, CORDAID, CRS, Difaem, ICCO, Islamic Relief, TSA, TBFF, Tearfund, WFDD, WV, (CHAs, all the denominational groups) …etc • Universities that network: BU, Emory, Georgetown, UCT, UKZN…etc

6. Currently: competing discourses and agendas • Different languages… ‘like ships passing in the night’ (KMarshall) • How do you put an epidemiologist, a theologian, an NGO manager, a policy-maker and a local religious leader in a room together… • …evidence through different disciplinary frameworks, with different languages, typologies, lenses and agendas • e.g. lack of basic consensus on the ‘unit’ of analysis… there is no common typology for ‘FBO’ • E.g. “All organisations in Uganda are FBOs!” • the basic religious-secular divide is problematic in itself…there is no ‘faith sector’… and ‘FBOs’ tend to fall in the grey areas

7. My top issues: • Context and complexity is unavoidable and must be dealt with • Faith-inspired initiatives (FIIs) continue to be unaligned with national responses • We need to continue to ‘map’ FIIs…all the way down to the messy community and non-mainstream level • The time for listing generalized comparative advantages/ disadvantages of ‘FBO’s as an advocacy tool has passed (they now do more damage than good) • We need evidence-based analysis of specific ‘differences’ • Broad-scale research that draws on quantitative and technical analysis is urgent … equally urgent is nuanced case-study research that takes context into account

8. e.g. Specific questions being asked now • Faith-sensitive indicators of impact or change… and standardized measurement tools and processes • Best practices for engagement with local faith communities • Community held assets (religious health assets) and systems (CSS) • Specific program or disease areas: e.g. best practices for strengthening immunization, resilience, MCH, HIV/AIDS • Intangibles or values: volunteerism, compassionate care, good governance, trust, motivation, • Beyond market share: to innovations, mechanisms, performance, quality, impact on most vulnerable, reach to the poor (e.g. Robin Hood), justice, access, sustainability, resilience…etc • Governance, leadership capacity and religious literacy

9. The widest ‘open door’ is ‘health systems’ • Health Policy and Systems Research an emerging field • Embraces context and complexity • Necessitates understanding FIIs as part of the system • Embraces multiple perspectives: • Interdisciplinary, includes social science, bridges community-provider divide and practice-research divide • Bridges development and public health • Software of the health system is as important as the hardware (e.g. people, values, perceptions, trust etc)

10. -end- • See www.irhap.uct.ac.za – other partner resources there • See “Strengthening the Evidence for Faith-inspired Health Engagement in Africa, Volume 1, 2 & 3” http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/0,,contentMDK:20131121~menuPK:578586~pagePK:148956~piPK:216618~theSitePK:282511,00.html

11. Rodriguez-Garcia et al. 2011

12. FBOs… Eg: church, congregation, religious community, faith-based institution, faith-based organisation, faith-based group, faith-related organizations, faith-background organizations, faith-centered organizations, faith-saturated organizations, faith-inspired organization, religious organization, religious-based organization, religious group, religious facility, religious institution, community-based organisation, church-based organisation, facility based religious entity, non-facility based religious entity, women’s groups, youth groups, faith-inspired network, national faith-based health network, faith-based networks, umbrella group, religious umbrella body … and many many more…

13. ‘Mapping the Mapping’ of Faith-inspired Health Initiatives ARHAP - Tsaba Tseka, 2006

14. e.g. Poverty Mapping e.g. World Bank, Poverty Mapping (Coulombe & Wodon, 2011)

15. e.g. MLH, Memphis

17. Recognising complexity Health systems are dynamic & interconnected systems at whose heart are people (see Gilson 2012, Alliance Reader)

18. Source,: Dimmock, Olivier, Wodon, 2012