Network development for non-state health providers: African Christian health associations

Abstract

Substantial effort has been put into forming and strengthening national networks of non-state, non-profit health providers in lower-to middle-income contexts. Christian health associations (national umbrella networks of faith-inspired health providers) were first established in the 1950s, and are currently present in an estimated 23 of the 54 countries in Africa. The establishment of CHAs was equally encouraged by faith-based health providers, governments, and external stakeholders. CHAs look different in each context, but perform similar roles: networking diverse institutions and facilities together into a loose system; and establishing a more cohesive sector to simplify and strengthen advocacy and engagement with the government.

Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system

“…The CHAG Secretariat have had a notably strong, long-standing collaborative relationship with the MOH [ 42 ], engaging effectively through successive governments, weathering periods of significant national turmoil and health system shocks. It is recognised that these findings on FBNPs geographic coverage may influence perceptions of CHAG’s role but these findings do not negate the value of their existing and potential contribution towards UHC or role in the national health system.…”

“…Similar to the other 22 Christian Health Associations (CHAs) present across SSA, CHAG is a network of local mainstream Christian member denominations that own health facilities [ 42 ]. Established in 1967, in a period of national upheaval, the original objectives set out by the founding members aimed to improve service coordination and to act as a consolidated platform for dialogue with the government [ 17 , 42 ] - objectives which still apply today. It is understood that a key founding focus was to provide services to marginalised, rural and most in need communities although actual motivations are not clearly defined in the historical literature.…”

“…FBNPs networked by CHAG are integrated with the public sector, submitting data to district health information software (DHIS) [ 44 ] and were put on the ‘fast track’ for NHIS accreditation. Due to this formalised integration and their long-standing role CHAG is considered one of the most robust CHAs in SSA [ 42 ]. Currently, CHAG reports that it has a membership of 282 facilities and 18 training institutions across all 10 regions of the country and constitutes 25 different ‘churches’ (Christian denominational groups).…”

“…Table 1 provides some insight into the tangible health system interventions relating to FBNPs that have resulted from periods of strong collaboration (such as the financial subsidies from government following the Adibo Commission and the signing of the MOU). Although relations between CHAG and the government are described as being generally robust [ 42 ], tensions have been reported, most recently in relation to the significant reimbursement delays in the NHIS scheme [ 45 ]. This recent tension is exacerbated by CHAG’s need to continually demonstrate their value and negotiate their position, particularly in light of the changing population dynamics, increasing urbanisation in historically rural areas (where CHAG facilities are traditionally present), and the developing capacity of the government to meet the health needs of the population through the public sector.…”

Public–Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study

“…Following the foundational Adibo Report’s 5 recommendations in the 1970s, the GoG began subsidizing health professional’s salaries in CMIs, and currently covers about 92% of these wages ( Yeboah and Buckle, 2017 ). Their cooperation was formalized in a 2003 MOU, with subsequent amendments in 2006 ( Box 1 ) ( Dimmock et al ., 2017 ). Today, CHAG is informally seen as an agency within the MoH with its own personnel similar (though to a lesser extent) to the GHS ( Yeboah and Buckle, 2017 ; Grieve and Olivier, 2018 ).…”