Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

ABSTRACT

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.

En Afrique subsaharienne, nombreux sont les individus à recourir à des prestataires de santé non-gouvernementaux, et l'existence de relations entre prestataires gouvernementaux et non-gouvernementaux est de plus en plus courante. Peu de travaux analytiques ont porté sur les modèles divers pour ces relations, ce qui a pour conséquence un manque de clarté sur les promesses et les relations publiques-privées en matière de santé. Malgré sa prévalence, ce modèle de relations est souvent un échec. Les prestataires de santé confessionnels constituent une proportion significative du secteur non-gouvernemental de la santé en Afrique subsaharienne, et le nombre de partenariats établis avec eux est en augmentation. En s'appuyant sur un projet de revue systématique antérieur qui a déterminé une typologie des modèles organisationnels des relations publiques-privées dans le secteur de la santé, cet article rend compte d'une analyse secondaire qui met l'accent sur les initiatives dans ce domaine, impliquant des prestataires de santé confessionnels.

Muchas personas dependen de proveedores no estatales para accesar a servicios de salud en el África subsahariana, lo que determina que la interacción entre proveedores estatales y no estatales sea cada vez más común. Existen pocos estudios analíticos que aborden los distintos modelos de interacción, razón por la cual hay falta de claridad respecto a los acuerdos y los retos establecidos en el área de la salud a partir de la interacción público-privada (ipp). A pesar de su prevalencia en el sector salud, es frecuente que las ipp no cumplan con las expectativas. En el sector de salud no estatal del África subsahariana los proveedores de salud basados en la fe (psbf) constituyen una proporción significativa del total y se evidencia que el número de alianzas con psbf sigue en aumento. Aprovechando un proyecto previo de revisión sistemática que estableció una tipología de modelos organizacionales para las ipp en el área de la salud, el presente artículo da cuenta de un análisis secundario, destacando las iniciativas de ipp con los psbf.

KEYWORDS:

• Social sector – Health
• Civil society – Partnership
• Sub-Saharan Africa

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Eleanor Whyle is a researcher and PhD candidate in the Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town.

Jill Olivier is a Senior Lecturer and Research Coordinator at the University of Cape Town in the School of Public Health and Family Medicine, Health Policy and Systems Division. She is the Director of the International Religious Health Assets Programme (IRHAP) and holds a PhD in Development Sociology.

ORCID

Jill Olivier http://orcid.org/0000-0001-9155-6896

Notes

1. It is important to note that the categories that we are working with (public vs private, PNFP vs PFP) are not always as rigid as this type of classification (and modelling by type) suggests. For example, FBHPs are often more “public” than “private” in orientation, and the difference between PNFP and PFP is often not as obvious as it would appear (for example, most FBHPs generate internal funds through income-generation activities). Such classifications are better understood as existing along a continuum (see Giusti, Criel, and De Béthune 1997).

2. For example, in Tanzania, the same coordinating body, the Christian Social Service Commission (CSSC) manages both health and education services of different faith communities.

Additional information

Funding

The secondary analysis of the systematic review project on PPE (in relation to FBHPs) was in part supported by the Alliance for Health Policy and Systems Research, WHO with funding from IDRC Canada.