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Tension between mission hospitals and national authorities

11 July 2012

In many countries there is a tension on the relation between faith-based care organisations and the national authorities. In developing countries this leads to problems, because hospitals managed by confessional organisations provide a large part of health care. Scientists of the Antwerp Institute of Tropical medicine studied the problems, based on the contractual relations in four African countries, and wrote a book about it.

Supported by Medicus Mundi International, a netwerk of NGOs, from 2007 to 2009 they studied the contractual relations between confessional organisations and health authorities in four Sub-Saharan African countries: Cameroun, Tanzania, Chad and Uganda. Mission hospitals or faith-based organiations in Cameroun, Tanzania and Chad are commissioned by the authorities to directly deliver medical care, or to manage health care delivery in a district. In turn they receive money or other benefits, for instance human resources. In Uganda denominational hospitals worked partly uncer contract for organisations (“primary recipients”) that themselves had received money from the American aid program Pepfar (President's Emergency Plan for AIDS Relief).
The authorities use the contracts to offer better care to their population, certainly in rural areas; while the Churches strive for official recognition and support.
It is not self-evident that these contracts work. Do they? And why (not)? The scientists interviewed people on all levels of the health car pyramid, and analysed a mass of data. It was clear there were tensions, even though the officials were not always prepared to recognise it. Both parties were not really prepared, which means the agreements were often vague or incomplete – or they were never put to paper. Often they did not fit into the more general policies. There was a large dichotomy in understanding between the central level and the local health authorities, due to an incomplete decentralisation process, making the policies very fragmented. The contracts made hardly a difference to the shortage of money, people and means. And often the government did not keep its promises, contract or not. Only when the means were available, as in the case of Pepfar, the contracts came up to expectations.
Even though the ‘Pepfar-contracts’ had the tendency to short-circuit the national structures, they ware appreciated by the people in the field, because they were dependable and had clear mechanisms of follow-up and evaluation.
If Churches and civil authorities want to cooperate in health care, they better revise their historical agreements and understandings, and go for contracts with clear follow-up and evaluation procedures, the scientists conclude. But even though the contracts have to follow these general rules, the most important thing is to be adapted to the local circumstances.

You can order the book with Rita Verlinden,