perceptions and expectations research under stakeholders of christian health agencies christina de...
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Perceptions and expectations
Research under Stakeholders of Christian Health Agencies
Christina de Vries & 4-country team.
Four country studies
• CHAZ Zambia Chiku
• CHAK Kenia Masheti
• UCMB / UPMB Uganda Ssengooba
• CHAG Ghana Cleo Gayi
Contribution of Christian Health Networks to the National Health Sector in Select African Countries
0
10
20
30
40
50
60
70
80
90
100
Liber
ia
Ghana
DRCongo
South
Sud
an
Kenya
Ugand
a
Tanza
nia
Mal
awi
Zambia
Zimba
bwe
Leso
tho
Fa
cili
tie
s
FBO MoH
Study questions
1. Main strategic objectives of the CHAs and their members to work with the Icco Alliance and Cordaid and vice versa ?
2 What can be the role of CHAs and their members to improve access to PHC for marginalized groups ?
3. What can be the added value of ACHAP for the CHAs and their members ?
Perspectives from Icco and Cordaid (1)
• Changing context
• Changing funding arrangements
• Changing theories-of-change
Synergy donor – CHA policies ?
Objectives intrinsic to
- Dutch donor- the CHA network and
of benefit to the members
- worth supporting ?
Objectives identified for partnerships and external support
• Programs• Alliances• Complementing
government health services
• HRH development
Perspectives icco and cordaid (2)
Limitations CHAs:
- Management and governance capacity
- Doubts about representation & ownership
- Doubts about influence circles,- Icco and Cordaid little influence on CHAs.
Governance
• Representation– membership– network arrangements– transparency and credibility
• Participation– capacity
• Quality of network support– responsiveness
• Expectations
Perspective CHIs towards CHAs
results (1)
• CHAs different history, different contexts, different mandates
• CHAs similar network challenges, similar funding challenges, more uniformity in public-private relations
results community level stakeholders (2)
• Sharp criticism from community levels to northern agencies: call for solidarity and commitment particularly in times of crisis !
• FBO health care much needed in rural settings• Advocacy for health needs more linking of
grassroots and national fora:– Empowement of VHCs, participation in governance
and planning– Dat collection, PME to be improved (ICT ?)
Minga High School
Chipembe Stores
Menyani Rural Health Center
Nkopeka Rural Health Center (Nyimba District)
Menwe Rural Health Center
Mumbi Rural Health Center
Mwanja Bantu Rural Health Center
Minga Mission Hospital
Minga Stop NBH Committee
Bangwe NBH Committee
Kasusu NBH Committee
Mangomba NBH Committee – 12Kms from Hosp.
Kanjoka NBH Committee– 14Kms from Hosp.
Nyika NBHMvuvye NBH Committee
Chitiwi NBH
Mulira NBH
Lwezi NBHChimate, Kaluba, Kasondo, Mwambezi,NBH’s
Nyamatepo NBH
Njeemi NBH
Malowe NBH
Medical Referrals
AR
T
ART
ART
AR
T
ART
Medical Referrals
Medical Referrals
Minga Mission provides Medical
and ART support… all NBH
CommitteesMinga Mission provides
ART Services and Additional HR through
Community Health Workers (CHWs) … all Rural Health Centers
(RHCs)
•Training of CHWs & Posting to all RHCs.•Client Feedback through NBH•RHCs Partners in delivering Health Services
•Training of CHWs & Posting to all RHCs.•Client Feedback through NBH•RHCs Partners in delivering Health Services
Great East Road
Catchment Population: 22,650
Minga Mission Hospital and Interactions with the Community in Petauke District
results (3)
• Representation and participation: contradictory views
• Monitoring and information management,– Needs innovation
• Shortage of health personnel, more management demands not the solution.
results (4)
• Larger member institutions benefit relatively more from CHA resources than smaller ones; also true for CHAs within ACHAP or GF access
results (5)
Relation with the governmental health sector:
• MOUs and contracts
• Dependency
• Complementarity
• Compliance and harmonisation with MoH
• Some advocacy on behalf of members, little on behalf of healthcare users
results (6)
Diversification of funding sources, funding tracks and funding requirements:
- Rights-based, empowerment- Post-conflict- Performance-based orientation- Resource tracking right down to the
beneficiaries- Shift from system support to program
support
results (7)
Advocacy:
- Confused and diffuse concepts
- Shift target from MoH to MoF
- Alliance-building, input-result difficult to assess
- Constituency-base is an asset
- Capacity is a challenge, funding ?
- CHAs and Church
The renewed definition of PHCThe renewed definition of PHCFocusing on the health system as a Focusing on the health system as a
wholewhole
• Include public, private, and non-profit sectorsInclude public, private, and non-profit sectors
• Recognize PHC as more than provision of health services:Recognize PHC as more than provision of health services:
• Differentiate values, principles and elementsDifferentiate values, principles and elements
• Highlight equity and solidarity;Highlight equity and solidarity;
• Incorporate sustainability and a quality orientation. Incorporate sustainability and a quality orientation.
• Specify measurable organizational & functional elements Specify measurable organizational & functional elements
• Recognize dependency on other health system & social processes Recognize dependency on other health system & social processes
• Recognize need for each country to design their own strategyRecognize need for each country to design their own strategy
Recommendations
• Support to CHA as a health system• More guidance in shift towards
programmatic approach; serious attention for adverse effects
• More attention for advocacy and lobby: capacity, multi-level system and agenda.
• Recognition and positioning of CHAs as major actors.
• Role for ACHAP.
Thank you.