This session was an opportunity to discuss the potential for greater partnership between healthcare actors and faith communities, and to identify and address some of the obstacles to realising the potential of this approach. A number of broad conclusions arose, including the following:
- More and better partnerships are needed – the potential gains of engaging faith communities deeply in health care provision, including mental health, are huge, and great opportunities are being missed.
- Platforms are needed to facilitate this process, at all levels from the local to the international. But in pursuing these, care must be taken to make the best possible use of existing structures rather than duplicating work already done.
- Healthcare needs to address prevention, sanitation, affordability and access as well as treatment. Faith communities have huge leverage to exert change in attitudes and behaviours in all of these areas.
- In making partnerships with governments, the private sector and financial organisations, faith communities need to be aware of the danger of immersion in power politics. We cannot assume shared values or shared codes of conduct. Such codes are a vitally important part of the commitments we need to undertake.
- All those present expressed a desire to see this happen, and to work together. There is a huge shared will to engage in these projects.
What follows is a condensed point-by-point summary of the discussion.
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Jean-François de Lavison, President and Founder of Ahimsa Fund: Faith communities have always had a strong involvement with, and ownership of, healthcare; and they operate close to the most vulnerable populations. Ahimsa continues to push for greater representation of faith-inspired organizations in global health partnerships.
Azza Karam, Secretary-General, Religions for Peace: Faith inspired work is built on engagement, service and advocacy. There have been some advances in this space of late. A Vatican Commission is assessing this work; Religions for Peace has fostered many partnerships; the Global Fund has worked to support these efforts; and there are other examples. We need to assess what happens when business meets faith-inspired engagement and delivery – what partnerships and reflections result, and what concerns become evident.
Martin Palmer, Founding President & Interim Chief Executive, FaithInvest: The world of religion and faith is often not taken seriously because it is widely assumed that its main role is to preach. Preaching is one element of what faiths do, but they are also major stakeholders – together making up the third-largest investing group in the world. Fifty per cent of all schools and 64% of schools in sub-Saharan Africa are faith-owned, as are one-third of all universities and medical facilities. To look at faiths as people and organizations who keep the planet going, in an utterly pragmatic way, is to see them differently. Faiths own 8% of the planet’s habitable surface of the planet, and a further 15% is considered sacred; they have been building infrastructure for millennia. Despite this, they have allowed themselves to be marginalised. A patronising attitude from secular authorities means they often miss out on a seat at the table.
Faith Invest is working against this, assisting all major faiths in their investment policies. Together, faiths could have the investment clout to change the planet – altogether there are 10 trillion dollars of religious investments – and they invest for the long term, thinking in generations, not three- or five-year programmes. 25 years is the average. With the World Bank, Faith Invest is working to create a just climate transition fund for faiths investing in infrastructure around the world, that will launch at the end of this year. A joint programme with WWF international called Faith Long-term Plans consists of long-term commitments by faith investors to manage their assets, investments, influence and resources to drive action on climate change, biodiversity and sustainable development over the next seven to ten years. They have also linked up with a Swedish organisation responsible for maintaining faith-owned hospitals and schools around the world to launch a massive worldwide refurbishment programme for these facilities.
Faith organisations cannot afford to end up in siloes, interested only in protecting their particular territories. They have the capacity to make a better world by buying, building, investing and educating in ways that match their beliefs. And there is no other field, apart from education, where faiths have a deeper commitment than the world of health.
Kim Tan, Chairman of SpringHill Management: Faith communities have vast outreach capabilities, but are not good at maximising them. One key area in which more could be done is preventative health – not just treatment and healthcare, but creating better living conditions and addressing diseases of poverty and overcrowding. With economic development, many people have started to live in better houses and environments and to control TB and malaria; but the poor have missed out. There has not been a new TB drug in 40 years. Faith communities should think about prevention, sanitation and affordability. Affordability can only happen with import substitution. Expensive drugs, medicines and diagnostics are still imported into poor countries, but instead investment in local manufacturing is required. Spring Hill has a facility producing low-cost diagnostics in Thailand to address that, but similar plants are needed in Africa and elsewhere. Access is also key: centralised models lose patients. Other models – using trains to deliver services in India, or pre-equipped transportable container units in South Africa – increase access and deserve investment. Beyond bricks and mortar, faiths should focus on access and prevention.
Christoph Benn, Director for Global Health Diplomacy at Joep Lange Institute: Faith communities play an important role in global development, particularly through championing primary healthcare and providing services for the most vulnerable. In times of stress the importance of that role is even more evident. This was the case with Ebola in West Africa in 2014-15; and it is the case with COVID-19 now. The challenge for the rest of us is to support faith communities as they do their jobs for the most vulnerable. Often the interventions needed are simple, as illustrated by the example of a faith hospital in Tanzania where Dr Benn used to work, which had previously been proud to produce its own oxygen using an O2 concentrator. On a recent visit, just before the pandemic, the concentrator was not working for the want of a few spare parts. On the brink of COVID-19, the capability to produce a highly precious resource was there, but a simple question of access and logistics meant it could not serve as it should. The links and cooperation between faith communities and the private sector that could have facilitated contact with people who could repair this machine, at very low cost, for huge proportionate gain, were missing. Sometimes minimal but targeted investment can really help facilities serve communities better. Faith communities need better capacity to communicate with those who can support them in their ministry, and improved links with the private sector. Huge synergies are possible, but they are not talking.
Peter Yeboah, Executive Director, Christian Health Association of Ghana: In most African countries 30-70% of healthcare is provided by faith organizations of one kind or another. They represent key constituents, and are often the only representatives of underserved, marginalised, deprived and neglected populations. Maintenance and investment of existing facilities is much needed. Great gains could be made through the provision, repair and/or maintenance of water, sanitation and hygiene (WASH) in healthcare facilities – especially as we boost demand for healthcare services during the pandemic.
Holistic health is the path to take. Non-communicable diseases are now the number one cause of morbidity and mortality. Work is needed to leverage faith-inspired communities to address avoidable health conditions. In Ghana, for example, 71% of people identify as Christian. Church leadership has huge power to mobilise convening power and trust to promote health.
Faith-based provision could also be improved by strengthening supply chains – for example, by churches collaborating with Pharmaccessgroup to ensure last-mile distribution of affordable, high-quality medication. There are also opportunities for local production of vaccines, consumables, diagnostics and medication. Investment in strategic partnerships and collaborations with the private sector is key. Reliance only working with governments risks secularisation of faith-based systems, when faith communities should be looking to strengthen their identities and independence. COVID-19 provides important opportunities to harness goodwill and solidarity as we recognise the power and relevance of all partners.
Agus Samsudin, Chairman, Muhammadiyah: The healthcare industry has been providing goods and in-kind donations in Indonesia through the pandemic, but there has been no structured development of this development to match that seen elsewhere. No good system has yet been developed to manage relations between healthcare industry and faith communities. Muhammadiyah is coordinating 115 hospitals throughout the country. This represents a big opportunity for collaboration: that many hospitals can do a lot of things. There have been some partnerships with companies outside health, such as Unilever — and with multilateral bodies like USAID, WHO and UNICEF on public health.
Vinu Aram, Director, Shanti Ashram: The problem of ignoring healthcare has been around for many years. Weak health systems and a general lack of effective partnership are not new phenomena. COVID-19 offers an opportunity to emphasise partnership for health provision: the world has woken to the fact that lack of investment in health can cause huge disruption.
Faith communities have a long tradition of infrastructure and service delivery, but also the ability to speak about health and wellbeing. “Building back better” must include valuing health and wellbeing. The intersection between health and human security is increasingly obvious, and the landscape is not even – death and mortality are not equally shared across societies. Faith communities have large and important roles to play here, and conversations are needed that go beyond infrastructure. Health must be approached as a fundamental human right and a shared aspiration.
India is subject to multiple, overlapping crises. There are important partnerships to be explored between faith communities and the private sector, and around investment in children. Preventive health interventions require all of us to come together: for example, most vaccines come from a combination of public investment and private sector development. In this area, Religion for Peace has been working on two main things: vaccine equity and better communication around vaccine hesitancy. A number of lessons have emerged. Faith communities have important roles not just in service delivery and emergencies, but also in addressing the determinants of health: social inclusion, gender, justice, care for children born into poverty. Mutual learning is needed in these fields. We need to talk more. Discussing materiel and architecture its easy; talking about social and cultural determinants of health – child marriage, violence against children, etc. – is not. Faith organizations can work with the private sector to reduce this, including by building mutual literacy on preventive health services and the determinants of health. Existing institutions and capacities need to be strengthened, with individual institutions investing in platforms that can address complex problems. Finally, all of us need to work harder to make the case for children. They are going to be very traumatised by the events of the last couple of years.
Vinya Ariyaratne, President, Sarvodaya Shramadana Movement: The pandemic has been challenging in Sri Lanka, where faith communities have faith, doctrine, teachings, clergy, followers, and places of worship—but where not all have behaved well in response to COVID. Some places of worship became super spreaders; some leaders failed to address stigma, or to spread correct information. Some even spread mis- and disinformation. The private sector has also behaved badly, including by exploiting people for disproportionate profit around tests and treatment. While not universal, these failings have been widespread enough to make it hard to conceptualize effective approaches to partnership.
For the last 18 months, the Sarvodaya Shramadana Movement has mobilised by taking elements of doctrine from the teachings of all major religions in Sri Lanka, relating them to the dynamics of COVID transmission, and mobilising religious leaders to use that information in their sermons. This has helped make messages on issues like hand hygiene and social distancing more relatable. The movement has also worked to bring solace in sometimes very difficult conditions – for example, when pandemic responses have meant that last rites could not be performed. Sri Lanka has seen enormous psychological and physical suffering from COVID-19.
The Ministry of Health has now recognised the important role of religious leaders, and formed a group to establish how best they can work together. This has had a big impact and the network is now being used to carry messages about vaccines.
Katherine Marshall, Executive Director, World Faiths Development Dialogue, Georgetown University: Many of the lessons we have learnt in the past about the complexity of engaging religious organisations have not been heeded through the pandemic. As we approach the G20, we need to bring these lessons clearly into discussions about what happens after COVID, and how to prepare for the next pandemic.
Manuela Pastore, Global director for Making More Health, Boehringer Ingelheim Corporate Center: Boehringer Ingelheim’s “Making More Health” programme is active in different countries, working for a better, healthier world by facing a range of challenges around health, including by working with faith-based organizations. Often, when asked how these organizations want to be helped, the stock response is to ask for money. Only over time can trust be built so that people open up and start to co-create. There needs to be more on the table than money – including longer term approaches like income generation, business training and digital health training. Learning programmes are key.
Jean-Antoine Zinsou, General Manager Philippines, Sanofi Pasteur: Co-creation has to be the focus. The pharmaceutical industry has realised that it needs to be more patient-centred, structuring effective advocacy around patients’ health journeys. Industry does not currently have the know-how or the legacy to contact communities in any real sense. Partners are needed to help bridge that gap, and faiths could be important here. A platform is needed to encourage dialogue between the pharmaceutical industry and faith organisations. Common ground and objectives are already there, but a combined force is needed to achieve real improvements together. The industry is more open to this kind of dialogue than it was before.
Aamir Khan, Chief Executive Officer, Alcela: When consumers are not well informed, and maybe not literate, it is important not to rely on marketing or engagement with individuals. In these contexts community-based engagement is critical; and work with faith organizations is one of the best ways to do that. These organizations often have long standing relationships with the patients that need to be reached. The private sector is more successful at accessing patients when it goes through faith-based intermediary organisations with existing relationships with community members. But this requires work outside the normal comfort zones, trying to convince religious leaders that things like insurance packages are relevant.
Kelly McCain: The engagement of faith organisations in investment strategies and in business investment in communities is crucial. Faith organisations can help ensure that planned interventions are needed, clarify what communities want and need, and ensure that the measures taken are sustainable, not just for a couple of years. They have crucial roles to play in ensuring that investments are strategic, and that the public and private sectors work together and pool resources rather than investing over each other.
Wim van de Helm, Healthcare Development, EMEA-LATAM, Roche Diagnostics International Ltd.: Roche normally deals with ministries, regulatory bodies and large funders, and historically has neglected faith-based organisations. The industry has realised, however, that it needs to offer end-to-end solutions. These inevitably include parts of the puzzle for which other stakeholders are far more capable. For example, primary screening for human papillomavirus is the best tool to identify risk of cervical cancer in lower- and middle-income countries; but the patient journey from access to vulnerable populations through testing to treatment is complex, and held back by simple but serious problems such as stigma around sexually transmitted infection. There are many aspects to addressing this that industry neither owns nor really understands. There is a need for partnerships to look at complete solutions, analysing which populations can and should be served with what services, identifying objectives and hurdles, and addressing them. Looking at the earlier example of the oxygen concentrator, there are so many easily-fixable examples where tiny missing pieces collapse whole value chains.
Renier Koegelenberg, Executive Director of the EFSA Institute for Theological and Interdisciplinary Research: An international platform is needed to look at issues around the engagement of faith in health. Health is holistic – for example, the biggest relevant issue in South Africa is food insecurity. If you’re fighting to eat, treatment and testing aren’t important. South Africa has a strong public health system but it fails to cope with poor populations and has been overwhelmed by COVID-19. Potential and resources are lost through inefficiency and fraud. A domestic platform is needed to address issues at different levels of government and engage faith communities. It is impossible to scale up responses without local communities supporting people in many ways, including psychologically. Faith organisations have enormous infrastructure that is unutilised in health education and treatment. On a global scale, this can only be fixed through international forums.
Azza Karam, Secretary-General, Religions for Peace: We emerge from this discussion with the clear need for a platform. But some such platforms already exist, such as inter-religious councils. We need to work through these places, where communities already congregate to deliver services, advocacy and guidance, rather than immediately creating new ones.
The point about co-creation is nuanced. It must be a two-way process that sees religious communities not only as recipients of support from governments and the private sector with which to enhance services and strengthen service delivery institutions but also as communities that can contribute themselves with finance, infrastructure, programmes, projects and initiatives. These are two distinct arenas. Both are important.
Partnerships with faith organisations are often not partnerships of equals. We do not all live and love together all the time. There is a lot of goodwill to be harvested around the COVID response, but we also must recognise that several religious organisations have refused to collaborate and serve together. For example, Religions for Peace was meant to help the religious community co-create together, but they have not done it. They serve, but they are not sufficiently committed to, knowledgeable about or interested in serving together.
As long as religious organisations continue to fail in this way, we need to think carefully about the likely impact of more financed and more powerful organisations coming in for partnerships. Who will they work with? Will they enable specific organisations backed by the private sector to become very powerful? We should work for a world where all religious organisations work to serve existing inter-religious structures rather than one where a chosen few become powerful in the service of politics rather than religious coexistence. There is a danger of immersion in a political space that undermines democracy, good governance and respect for human rights. In many ways, COVID-19 has propelled us not to be better servants together, but rather to deepen existing political and financial chasms.
Faith communities need to take this danger into account, practically and pragmatically. We cannot assume shared values or codes of conduct, and it is vitally important that we have such codes. This is a crucial part of the commitment we need to undertake.
Jean-François de Lavison: The speakers have expressed clear interest and willingness to move forward in this exciting area. Together we will investigate how to develop these partnerships with religious communities—an approach that is likely to demonstrate the great value of innovative models and partnerships between different actors in global health. Only together can we achieve the goals of UHC.