Guest introduction: faith and health in development contexts

Today it seems completely uncontroversial that faith communities around the world are recognised for making a great contribution to development. Many secular international organisations have special positions for relations with faith-based organisations (FBOs) and have made it a matter of priority to cooperate with them. Several government agencies together with international organisations have recently created the International Partnership on Religion and Sustainable Development (PaRD; see Duff et al. 2016). In a recent editorial of The Economist, titled “Aid to fragile states”, it is recommended that donors and governments should channel money to NGOs and churches if they want to reach people in remote areas (The Economist, 18 March 2017). However, this has not always been the case. Long before there were even the terms “development aid” or “global solidarity”, churches and faith communities began to provide health care and education to people who had otherwise no access to these services. Building on a long tradition of engagement in education and care for the sick and destitute, churches and religious charities accelerated the establishment of schools and hospitals, applying new knowledge that became more available from the middle of the nineteenth century.

When the church expanded its work to countries in Africa, Latin America, and Asia, many of the newly founded missionary societies regarded it as their moral obligation to provide healing for the sick in the countries where they were operating. These institutions provided education and health care based on the available knowledge of their time and contributed significantly to the rudimentary health and education systems of many countries. Still today, churches and other faith communities maintain significant networks of clinics and health facilities, often in the rural areas of countries, particularly in Africa but also in Asia and Latin America (see Benn 2002, 2011; Olivier et al. 2015).

However, when governments of wealthy countries began to engage in global development cooperation and finance some years after World War II – working with the still young Bretton Woods institutions and the emerging UN system – the approach was strictly secular. With few exceptions, FBOs were not considered equal partners and overall development economists looked at the religious sector with a certain degree of suspicion, concerned that development theories should not be influenced by religious ideology.

The quality of cooperation changed significantly with the initiation of the Millennium Development Goals (MDGs) in 2000. With the establishment of ambitious global goals endorsed by all political leaders and civil society at large it was realised that only a massive, comprehensive global effort involving all possible partners could get us to achieving these goals. Many international secular organisations realised that faith communities could be great partners in the promotion of internationally agreed development goals. Following the International Conference on Financing for Development in Monterrey (2002), financial resources for development increased significantly and FBOs became important partners in the implementation of many programmes. Providing one example, The Global Fund to Fight AIDS, Tuberculosis and Malaria has recognised the importance of FBOs as full partners since its creation in 2002, and has channelled more than US$1.3 billion through faith-based partners on all continents to implement programmes addressing the major infectious diseases and to build resilient and sustainable health systems (The Global Fund to Fight AIDS, Tuberculosis and Malaria 2008, 2016a). A particular focus was placed on countries where churches and faith communities already had a substantial health infrastructure, and on fragile states where governments are particularly weak and have a limited capacity to reach their populations.

One interesting example is the Democratic Republic of Congo (DRC) – a vast country with an extremely challenging infrastructure and a government that can hardly reach its population beyond some urban centres. FBOs, on the other hand, are reaching even the most remote parts of the country, and have provided many of the essential services for many years (see Bennett et al. 2017). DRC is the third largest portfolio of The Global Fund globally. Because of the challenging environment, The Global Fund has been working predominantly with non-governmental actors, and around 75% of all its resources in this country are channelled through faith-based partners, including Eglise du Christ au Congo, Cordaid, and Caritas. The results have been quite impressive, considering that more than 70% of households now have at least one impregnated bed net to protect them from malaria, with the result that malaria mortality has decreased by 72% since 2000. These programmes in DRC might be considered a classic example of the MDG era, with very focused interventions helping to achieve concrete impact, but not necessarily addressing the overall context in a given health system, and the interlinkages between the various sectors influencing health.

Moving on from the MDGs, we now have much more ambitious goals to achieve. In 2015 the world agreed on the more comprehensive Sustainable Development Goals (SDGs), requiring a different approach which will also affect the role of faith communities in development. One important shift is that the SDGs (even more than the MDGs), are obliging all countries at all stages on the development continuum to develop plans on how to achieve these goals. No country can claim that all citizens have full access to all life-enhancing services. In many countries, inequalities have actually increased leaving many marginalised groups without adequate and affordable services. This is certainly true for the health-related Goal 3 (“Ensuring healthy lives and promoting the well-being for all at all ages”). “Faith communities”, almost by definition, do have a more holistic view of life. They are not usually specialised agencies, nor are they representing particular interest groups. They are looking at all aspects of the fullness of life, including the spiritual dimension. People simultaneously need shelter, decent jobs and the ability to contribute to the life of societies and communities, food, clean water and sanitation, a sustainable environment, good health, gender equality, access to quality education at all levels, and very importantly, life in peaceful communities with respect for people in all their diversity.

The SDGs are not only about services provided. The achievement of these goals requires the promotion and protection of common values and universal human rights. As we have experienced through recent political developments in different countries, these values cannot be taken for granted. They are under threat by nationalistic movements whose political agenda is fundamentally opposed to universal values and global solidarity. In some instances, religion is being used by these very movements to provide some form of legitimacy to their nationalistic agenda. But there are also excellent examples of religious communities engaged in reconciliation and peace-building that can become instrumental in providing better conditions for health and development. Muslim and Christian religious leaders in northern Nigeria have worked together to overcome existing tensions and pave the way for successful vaccination campaigns and other health interventions that brought the world closer to the historical goal of polio eradication (see Olivier 2016). This kind of multi-faith collaboration and peaceful community building is happening every day in many countries around the world.

Therefore, the role of faith in development is more important than ever. Faith communities are not just service providers for certain aspects of development goals, they are key voices and advocates for a life-promoting environment and for the inclusion in the benefits of development for all people. They need to be involved in policy discussions and in political advocacy to help establish the right conditions for international cooperation and global solidarity.

The SDGs are challenging the faith community and the international development community to work together even more closely. This new partnership model should include many different aspects such as political advocacy, resource mobilisation, policy dialogue, programme coordination, and implementation. Many excellent concrete examples of partnerships featuring faith and health in development are described in this special issue.

Let me briefly mention as one of these new models the partnership between The Global Fund and the United Methodist Church (UMC). The UMC has been active on many aspects of social work for centuries and has had a special focus on health and well-being. The Global Fund and UMC agreed not only to work together on malaria elimination in many of the high-burden countries in Africa, but also to engage in joint fundraising and advocacy. As a result, the UMC in the United States of America has raised more than US$60 million for malaria programmes, including US$20 million channelled through The Global Fund, and has been advocating for political support for global health in many international events, some jointly organised with The Global Fund (The Global Fund to Fight AIDS, Tuberculosis and Malaria 2016b, 2017). Similar partnerships have now been launched with Catholic Relief Services and World Vision International – towards looking at health and development in a comprehensive and holistic way (Friends of the Global Fight 2017). Partnerships of this kind require regular dialogue between these institutions at various levels, the organisation of joint events and field visits, agreements on when and where joint political outreach might be feasible, and most of all, the development of mutual trust and familiarity with the principles and values of the respective partners. This mutual investment in a common understanding is definitely worth the effort, as the potential benefit of these comprehensive partnerships for development is huge.

Looking again at global health, we have to understand the enormity of the potential for the future. Not a distant future several generations from now, but the more immediate future until the next goalpost of 2030. Since 2000 there has been great measurable progress – even if (of course) not all goals were achieved by 2015. There is still an unfinished MDG agenda, and too many people have been excluded from the progress achieved so far. Yet, there is one indicator that shows most clearly the direction the world has been taking. Globally, life expectancy increased from about 62 years to nearly 72 from 1980 to 2015 – with several nations in sub-Saharan Africa rebounding from high mortality rates due to HIV/AIDS. Life expectancy has grown faster in low-income countries than in the most advanced economies. Life expectancy is not only of importance because life is the pre-condition for all other development aspects; it also requires all elements of life-promotion to come together.

This has been expressed usefully by Professor Angus Deaton, the 2015 Nobel Prize Laureate in Economic Sciences:

“Life is better now than at almost any time in history. More people are richer and fewer people live in dire poverty. Lives are longer and parents no longer routinely watch a quarter of their children die  …  Of all the things that make life worth living, extra years of life are surely among the most precious.” (Deaton 2013, 1)

In his landmark study, The Great Escape, Deaton takes a historical perspective, and describes how progress in living conditions has been shared unequally for more than two centuries since the beginning of the Enlightenment and the progress in science and technology. He also outlines with great statistical detail how the world has begun to grow together again, and how many indicators of health and well-being at the beginning of the twenty-first century are better than at any time before in human history. For our generation, it means that we are now at a point that allows us to develop bold new visions based on experience and solid projections. Recently, a high-ranking commission published a report called Global Health 2035: A World Converging Within a Generation. They expressed their conclusion as follows:

“A unique characteristic of our generation is that collectively we have the financial and the ever-improving technical capacity to reduce infectious, child, and maternal mortality rates to low levels universally by 2035, to achieve a grand convergence in health. Achievement of convergence would prevent about 10 million deaths in 2035 across low-income and lower middle-income countries relative to a scenario of stagnant investments and no investments in technology.” (Lancet Commission 2013, 1898)

This positive outlook should not lead us to underestimate the challenges that will be faced on the way. Still far too many people are left behind in low-, middle-, and high-income countries. They are not benefitting from the overall progress, and in some cases they are systematically excluded and marginalised. In many sub-Saharan African countries and particularly those classified as fragile states, living conditions have deteriorated and a combination of political instability and the inability of the international community to provide adequate support is leading again and again to humanitarian crises such as those being experienced right now in the Horn of Africa. Technology and innovations have helped to elevate hundreds of millions of people out of poverty and have contributed significantly to the recent progress in global health. But they are by no means sufficient to achieve the great convergence in health predicted by the Lancet study. Progress of that magnitude in one generation will require many factors to come together, and this is exactly why a renewed partnership between faith and development will be so critical.

One of the many lessons learnt over the past 15 years is that health programmes achieve the best impact if they combine appropriate technology at an affordable price, excellent programme management, and community participation. Nothing can be achieved without the full participation of communities affected by these programmes. This has been the experience of the global HIV movement, that was driven and implemented by people living with and affected by the disease. This was the experience of the Ebola crisis in West Africa, that was not overcome by the deployment of international teams of experts, but by communities responding to the unprecedented challenge. In all these cases, communities of faith have played a key role. They have the reach into the remotest villages, they have the trust of the people, and they exemplify sustainability by their continuous presence in communities over so many generations. This needs to be fully recognised by the international secular development community.

But it will require a mutual learning process. There are well-known controversies and confrontations between the beliefs and perceptions of some faith communities, and some accepted clinical or public health strategies (see Tomkins et al. 2015). Faith communities are facing their own challenges that prevent them from developing their full potential to contribute to a healthier and more equal world. There are still many policy issues that need to be addressed through open dialogue: many FBOs – particularly at the local level – still find it challenging to comply with the stringent requirements of international organisations if they want to access external funding; full engagement in development is still limited to too few religious organisations with a structure that enables them to have a voice and a representation at the global level, leading to an unsatisfactory situation in which multi-faith participation is sometimes more tokenistic than real.

But these obstacles are not impossible to overcome. They are so essential that we cannot afford to neglect them. Capacity-building on all sides, increasing knowledge and mutual understanding, could go a long way to expand existing partnerships and build new ones (Blevins, Benn, and Thurman 2016).

There is already remarkable progress improving the lives of millions of people – in spite of all challenges and remaining obstacles. The question is how we can accelerate this great convergence in health and development. A closer collaboration between the faith and the development communities will be one of the key factors to move faster towards these common goals.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Christoph Benn is currently the Director of External Relations of the Global Fund to fight AIDS, Tuberculosis, and Malaria and has been a member of the founding board of the Global Fund since its creation in 2002. He has extensive experience as a clinician and public health expert in many parts of the world and also served as chairman of the HIV/AIDS working group of the World Council of Churches.