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Appreciating assets: The contribution of religion to universal access in Africa
Abstract
The study, “Appreciating Assets,” documents the contribution made by religion and religious entities to the struggle for health and wellbeing in Zambia and Lesotho , in a context dominated by poverty, stressed public health systems and the HIV/AIDS pandemic. By mapping and understanding these Religious Health Assets (RHAs), the study calls for a greater appreciation of the potential they have for the struggle against HIV/AIDS and for universal access and offers recommendations for action by both public health and religious leaders at all levels. Through respectful engagement these assets have the potential to increase in strength and value and become more effective in the long-term sustainability, recovery and resilience of individuals, families and communities.
In sub-Saharan Africa many individuals rely on non-state health providers, and engagement between state and non-state providers is increasingly common. Little analytic work has been done on the varied models of engagement, resulting in a lack of clarity about the promises and challenges of public–private engagement (PPE) for health. Despite their prevalence, PPEs often fail. Faith-based health providers (FBHPs) form a significant proportion of the non-state health sector in sub-Saharan Africa, and the number of partnerships with FBHPs is increasing. Building on a prior systematic review project that developed a typology of organisational models for PPE for health, this article reports on a secondary analysis, highlighting PPE initiatives with FBHPs.
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.
The field of theology and development is a relatively new sub-discipline within theological studies in Africa. The first formal post-graduate programme was introduced at the University of KwaZulu-Natal, Pietermaritzburg, South Africa during the mid-1990s. In the early years it was known as the Leadership and Development programme and since 2000, as the Theology and Development programme. Over the past twenty years, this programme has graduated over 160 BTh Honours, 100 MTh, and 15 PhD students. This article outlines the history of the programme, addresses its ideological orientation, its pedagogical commitments and preferences in curriculum design. It further argues that theological reflection on “development” must seek to understand the prophetic role of the church in responding to the complexities of the social issues facing the African continent. Key to this discussion is the contested nature of “development” and the need for theological perspectives to engage this contestation through a social analysis of the global structures of injustice. This requires an engagement with the social sciences. It is this engagement of the social sciences with theological reflection, the essay argues, that has enabled the students who have graduated from the Theology and Development Programme at the University of KwaZulu-Natal to assist the church and faith-based organisations to become effective agents of social transformation.
The African Religious Health Assets Programme (ARHAP) mapped and assess religious entities engaged in health prevention, care, support and treatment, and developed tools for aligning religious and community health assets in partnership with formal health services and systems. This has provided evidence for just how widespread, and varying in range and type, religious entities engaged in health work are. Many of them, however, are not visible to formal public health institutions. Ubiquitous in many contexts, delivering large-scale services in the aggregate, individually they are often small, flexible, frequently grassroots-based or linked, and without the organisational and material capacities to make their presence and voice more widely felt. They do not easily find a relationship to formal health institutions or systems, though providing for a great deal of health interventions, often where state or corporate agencies do not operate well, or at all. I argue here, drawing on ARHAP’s experience, that one of the most critical factors in addressing this breakdown of an effective alignment of religious health assets and public health is the role of credible, or trustworthy, intermediaries. The earlier work by Thomas Carroll (1992), who analyzed thirty intermediary organisations in Latin America, helps us understand how to address this, especially with respect to the kind of intermediary he calls a grassroots support organisation.
The role of communities in health care has gained prominence in the last few years. Churches as community structures have been identified as instrumental in health-care delivery. Whilst it is widely acknowledged that churches provide important health services, particularly in countries where there are poorly-developed health sectors, the role of churches in health care is poorly understood and often overlooked. This article discusses some causes of this lacuna and makes suggestions for repositioning churches for a meaningful contribution to health care. Firstly, the article provides a context by reviewing literature on the church and health care. Secondly, it clarifies the nature of interventions and the competencies of churches. Thirdly, it discusses the operational meaning of church and churches for assessing health-care contributions. Fourthly, it explores the health-care models that are discerned in church and health-care literature. Fifthly, it discusses the contribution of churches within a multidisciplinary health team. Sixthly, it proposes an appropriate motivation that should drive churches to be involved in health care and the ecclesiological design that underpins such health care interventions.
The fight against AIDS in Africa is often presented as a fight against "cultural barriers" that are seen as promoting the spread of the HIV virus. This attitude is based on a long history of Western prejudices about sexuality in Africa, which focus on its exotic aspects only (polygamy, adultery, wife-exchange, circumcision, dry sex, levirate, sexual pollution, sexual cleansing, various beliefs and taboos, etc.). The article argues that those cultural aspects are a wrong target of AIDS prevention programs because they are not incompatible with a safer behavior, and because their eradication would not ensure the protection of people. To fight against them might alienate the people whose cooperation is necessary if one wants to prevent the spread of AIDS. The major problems of AIDS prevention in Africa are not specifically African, but are similar to the problems existing in Europe or America. Therefore, anti-AIDS projects should not fight against one local African culture in order to impose another (Western), but should rather try to make behavior and practises safer in a way that is culturally acceptable to people.
The Human Immuno-Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) have become a major health problem in Zambia. Because of the threat HIV/AIDS poses to the nation the government of Zambia embarked on a public health campaign aimed at combating the scourge. However so far this campaign has predominantly been conducted through modern channels of information communication. The overall objective of this study was to explore the role one particular traditional channel of sex information communication the initiation ceremony of girls could play in disseminating information to combat HIV/AIDS. Data were collected from five residential areas using systematic random sampling. Overall the study concludes that although there is no evidence to directly link initiation ceremonies with HIV/AIDS indirectly todays initiation ceremonies enhance the spread of HIV/AIDS. But it is encouraging to point out that given the demonstrated willingness of the majority of initiators to learn more about HIV/AIDS the identified inadequacies in initiation ceremonies can be removed so that this Channel is used effectively in the fight against the disease. (authors)
This paper describes a health education intervention which was conducted during the 1990 dry season in 3 study villages in the Northern Region of Ghana, to reduce dracunculiasis prevalence in that area by promoting the use of cloth filters for drinking water and avoidance of water contact by sufferers. The impact of the intervention in reducing dracunculiasis prevalence was examined by comparing the period prevalence of infection in 1990 and 1991. The findings demonstrate that the intervention had a measurable but limited impact on dracunculiasis prevalence. Face-to-face health education was successful in persuading 56% of households to buy filters. Ownership of at least one filter for every 10 people in the household was associated with a reduction of at least 20% in the risk of dracunculiasis.
To describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention.
A cross-sectional study conducted in a rural area in central Senegal.
Questionnaire-based interviews of a random sample of 858 adults from the general population aged 15-59 years and in-depth interviews of four religious leaders and 50 people.
Seventy-six per cent of the respondents were Muslim, 24% Catholic, 1% Animist and 0.2% Protestant. A total of 86% of men and 87% of women reported religion to be very important to them. Important prevention-related variables were inversely associated with the importance of religion. Men who considered religion to be very important were less likely to cite AIDS as a major health problem [odds ratio (OR) 0.4, P = 0.008] and were less likely to feel at risk of getting HIV (OR 0.5, P = 0.0005). Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS (OR 0.2, P = 0.0001), less likely to report having discussed AIDS with others (OR 0.4, P = 0.01) and much more likely to feel at risk of getting HIV (OR 9.3, P = 10(-4)). Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS.
These findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level.
Since the late 1970s when the first cases of HIV/AIDS were identified in Africa, there has been an upsurge of research on the epidemic. Although religious involvement may be germane to AIDS protective and risk behavior, few of these studies deal with religion and AIDS. This article contributes to the discourse on religion and health in Africa by analysing the interrelationship between religion and AIDS behavior in Ghana, a West African country at the early stages of the AIDS epidemic, and one where religious activities are more pronounced. We explore whether a woman's knowledge of HIV/AIDS is associated with her religious affiliation, and whether religious affiliation influences AIDS preventive (protective) attitudes. Findings from our analysis of Ghanaian data indicate that religious affiliation has a significant effect on knowledge of AIDS. However, we did not find religious affiliation to be associated with changes in specific protective behavior, particularly the use of condoms. The limitations and implications of the study are discussed, promising directions for further research on religion and AIDS protective and risk behaviors are also discussed, and the design and development of culturally sensitive programs to help in the ongoing AIDS prevention efforts in the region are proposed.
Using survey and semi-structured interview data collected in various religious congregations in urban and rural areas of Mozambique, this study analyzes how gender differences in perceptions of HIV/AIDS and preventive behavior are mediated by religious involvement. Logistic regression is employed to examine the effects of gender and of the interactions between gender and type of denomination--"mainline" (Catholic and Presbyterian) or "healing" (Assembly of God, Zionist, and Apostolic)--on female and male members' exposure to HIV/AIDS-related prevention messages, knowledge and perception of risks, and practice of prevention. The analysis detects women's disadvantage on several measures of knowledge and prevention but also suggests that gender differences are less pronounced among members of "mainline" churches. The semi-structured interview data further highlight how gender differences are shaped in different religious environments. Although the potential of faith-based institutions in combating the HIV/AIDS pandemic is undeniable, policy-makers need to heed important differences among these institutions when devising ways to harness this potential.
The HIV/AIDS epidemic in South Africa is rapidly escalating, and its demographic and social impact is beginning to be felt. Although the damage to the macro-economy is projected to be slight, the consequences for affected households will be dire, and social indicators such as life expectancy will deteriorate dramatically. A large majority of South Africans are affiliated to Christian Churches, but this has not prevented the types of sexual behaviour that promote the epidemic. Based on research in a KwaZulu township, this article presents evidence on the level of extra- and pre-marital sex (EPMS) among members of different church types. It is argued that only Pentecostal churches significantly reduce EPMS among members; and that they achieve this by maintaining high levels of four crucial variables: indoctrination, religious experience, exclusion and socialisation.
Study of the Response; Liebowitz, The Impact of Faith-based Organizations
- Foster
Foster, Study of the Response; Liebowitz, The Impact of
Faith-based Organizations;