1. CHRISTIAN HEALTH ASSOCIATIONS IN AFRICA Presented at CCIH Annual Conference May 29, 2005 Frank E. Dimmock P.O. Box 1266, Lilongwe MALAWI fdimmock@malawi.net

3. 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

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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

11. Central African Republic Rwanda Togo APROMESTO ASSOMESCA BUFMAR

12. 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

13. 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

14. 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

15. Government Donors Association Member Health Church Units/Programmes Leaders

16. 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)