CHRISTIAN HEALTH ASSOCIATIONS IN

AFRICA

Presented at CCIH Annual ConferenceMay 29, 2005

Frank E. DimmockP.O. Box 1266, Lilongwe

MALAWIfdimmock@malawi.net

Countries with CHAs - 12• Lesotho – CHAL• Zimbabwe – ZACH• Zambia – CHAZ• Malawi – CHAM• Tanzania – CSSC• Kenya – CHAK & KEC• Uganda – UPMB, UCMB • Sudan - CHAS• Nigeria - CHAN• Ghana – CHAG• Liberia – CHAL• Sierra Leone - CHASL

Characteristics of the Associations: Southern Africa

LESOTHO – founded in 1974, 8 hospitals & 75 HCs, ~40% of NHS, decentralised in 1984 to HSAs, formal agreement w/ GoL in 1991, Professional staff salaries + 20% operating budget/yr from GoL. Currently being restructured to District level. All health facilities digitally mapped.

ZAMBIA – founded in 1970, 30 Hospitals & 60+ HCs, ~ 30% of NHS, Professional staff paid by GRZ, MoU signed in 1996, Church Hospitals given 75% operating budget, decentralised to District Health Boards, CHAZ now includes non-institutional members. Mapping of facilities in process (05/05)

ZIMBABWE – founded in 1974, 52 hospitals & 68 HCs, ~45% of NHS, 8 DDH, fees set by Gvt., Gvt. Grant reduced by revenue amt., Gvt supports training schools.

MALAWI – founded in 1966, 28 Hospitals & 125 HCs, ~ 37% of NHS, MoU signed in 2002, All established positions reimbursed by GoM, Decentralisation now w/ district-level service agreements. All Health facilities digitally mapped.

CHA features cont’d East Africa

TANZANIA – founded in 1992, 81 Hospitals + 2 TH, 68 HCs, 21 DDH w/ 100% op expenses covered by Gvt., ~ 48% NHS, Block grants to Church hospitals, service agreements in prep.

KENYA – founded as CHAK in 1982, 24 Hospitals,43 HCs, 298 disp., 51 Church Health Progs., ~40% NHS, restructured in ’97, Area Coord. Cttees., new CHAK-GoK TWG formed, no gvt. grants rec’d since 1996. Digital mapping of Health facilities in process

KEC = Catholic Health Association

UGANDA – UPMB – founded in 1955, 17 Hospitals, 115 HCs, ~20% NHS, annual service-level agreements @ district level, Gvt. seconded staff.

- UCMB - founded in 1955, 27 Hospitals, 232 HCs, ~32% NHS, Gvt. supports ~ 30% operating expenses, PPPH office assists in collaboration w/ Gvt.

PNfP providers CR from fees = 43%. ~ 30% from gvt support. Service contracts since 2000. PPPH office established to enhance collaboration. Digital mapping of all Health Services in process

SUDAN – CHAS Founded on Friday, May 6, 2005. Lead

Agency in the formation is CEAS (Churches Ecumenical Action Sudan) Currently 4 general hospitals, 30 specialist hospitals, 5 training schools mostly managed by IFBOs ~30% HS provided by Christian INGOs & Sudan Churches

0 100

kilometres

200

Equatoria

Blue NileSouth Darfur

South KordofanWest Kordofan

Upper Nile

Warab

Eastern Equatoria

Bahr el-Jabal

Western Equatoria

Unity

Lakes

Westen Bahr el-Ghazal

Fashoda

Twic

Aweil North

Aweil West

Latjor

Kajo Keji

Budi

Kapoeta

Torit

Yei

TerekekaMundri

Rubkoana

Old Fangak

Rumbek-cueibet

Yambio Maridi

South Bor Pibor

Akobo

Raja

Waat

Pochalla

Oriny

Nyamlell

Gok Machar

UriangUrieng

Boma

Mangalotore

Torit

NarusKapoeta

Kimatong

Chukudum

Nagichot

Haforere

Ikotos

Mundri

MvoloAwerial

Cueibet

Midel

Rumbek

Aluakluak

Akot

Wullu

Billing Abuyong

Marial Bai

Nine Boli

Yambio

BaiditYomciir

Kolmerek

Nimule

Bahr el Ghazal

Upper NileNorthen Bahr el-Ghazal

Jonglei

AtarAweil East

Aweil South

Awerial

Ayod

Diror

Ezo

GogrialGuit

Juba

Koch

Leer

Magwi

Mayom

North Bor

Nyirol

Panyijar

Renk

Ruweng

Sobat

Tambura

Tonga

Tonj

Wau

Wuror

Yirol

Aburoc

Abyei

Adior

Ajiep

Akobo

Akon

AlekAroyo

Atar

Awada

Aweil

Ayod

Baau

Bararud

Beneshowa

Bentiu

Bieh

Bor

BowCelkou

Diem Zubeir

Duar

Duk Padiet

Duk Payuel

Faraksika

Fashoda

Ganyiel

Gogrial

Gumriak 1

Jaibor

Jiech

Juba

Kauda

Keew

Keyala

Kiech Kuon

Kier

Kotobi

Lankien

Leer

Lekongole

Li Rangu

Liethnom

Longochok

Lui

Malakal

Malual BaiMalualkon

Mapear

Mapel

Maper

Maridi

Nabagok

Nasir

New Cush

Nimnim

Nyal

Nyilwak

Nzara

Old Fangak

Padak

Panliet

Parajok

Pibor Post

Pochalla

Raja

Ramciel

Renk

Tambura

Tangyang

Tarakeka

Thokchak

Thokliet

Thonyor

Tonj

Udici

Udier

Wanding

Wau

Yabus

Yei

Yirol

Yuai

KEY

State (e.g. Western Equatoria)

County (e.g. Yambio)

Town/Settlement

SOUTHERN SUDAN

Region (e.g. Equatoria)

Unicef/OLS Apr05NB: The boundaries and names shown on this map do not imply recognition/endorsement by the UN

Features cont’d West Africa

NIGERIA - CHAN

GHANA – CHAG Founded in 1967, ~ 34% NHS, Developed QA & Accreditation system

SIERRA LEONE - CHASL

LIBERIA – CHAL Founded in 1975, 5 Hosp, 67 HCs, ~47% NHS, collab w/ MoH/SW in CBR, WASH, FLE, PSS.. Little institutional support

Central African Republic

Rwanda

Togo APROMESTO

ASSOMESCA

BUFMAR

Other Countries with Networks or Coordinating Agencies:

Ethiopia

CRDA

Botswana

AMMB

Angola

CICA

Democratic Republic of Congo

SANRU

~ 50% NHS by FBOs

Senegal

EPSCM

Namibia

NCC

Cameroon

FEMEC

Summary Characteristics of Associations• History of health networking (CMC of WCC established in 1968)

• Members provide significant portion of National H.S. & training of

Health personnel

• Formal agreement / MoU with Government & service agreements

@ District level

• Participate in National Health Planning & Policy setting

• Have implemented and facilitated health programmes

• Most related w/ WCC, EPN, and other international bodies

Core Functions of CHAs

Advocacy (Planning & Policy Setting)

Technical Assistance & Training (constructive encouragement)

Capacity building / Institutional strengthening (SP, OD, HR)

Resource Mobilisation / Administration (facilitate partnerships)

Research (ARHAP, HIV/AIDS)

Monitoring & Evaluation (establishing standards)

Joint procurement (MEDS, JMS) & equipment maintenance

Communication, Health Information

Government Donors

Association

Member Health ChurchUnits/Programmes Leaders

Challenges of Christian Health Associations:

• Mandate / Authority (advisory vs control)

• Financial Sustainability • Membership – composition & accountability• Diversity of membership (capacity variance)

• Relationship balance (with 4 corners)

• Communication (external and internal)

• Coverage (Geographic and programme)

• Leadership (turnover and commitment)

• Publicity (profile & evidence)