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The Difficult Relationship Between Faith-Based Health Care Organisations and the Public Sector in Sub-Saharan Africa

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The Difficult Relationship Between Faith-Based Health Care Organisations and the Public Sector in Sub-Saharan Africa The difficult relationship between faith-based health care organisations and the public sector in sub-Saharan Africa The case of contracting experiences in Cameroon, Tanzania, Chad and Uganda Delphine Boulenger and Bart Criel Studies in Health Services Organisation & Policy, 29, 2012 We dedicate this work to the late Professor Dr. Harry Van Balen, former Head of the Public Health Department of the Institute of Tropical Medicine in Antwerp, and former Chairman of the network organisation Medicus Mundi International. 4 Studies in HSO&P, 2012 Studies in Health Services Organisation & Policy, 29, 2012 Series editors: G. Kegels, V. De Brouwere, B. Criel ©ITGPress, Nationalestraat 155, B-2000 Antwerp, Belgium. E-mail: [email protected] Delphine Boulenger and Bart Criel The difficult relationship between faith-based health care organisations and the public sector in sub-Saharan Africa The case of contracting experiences in Cameroon, Tanzania, Chad and Uganda D/2012/0450/1 ISBN 9789076070391 EAN 9789076070391 2 Studies in HSO&P, 2012 Table of contents TABLE OF CONTENTS ........................................................................ 1 ACRONYMS .......................................................................................... 5 ACKNOWLEDGMENTS……………………………………………………………… 9 EXECUTIVE SUMMARY .................................................................... 11 INTRODUCTION ........................................................................................ 11 BACKGROUND .......................................................................................... 12 METHODS .................................................................................................. 14 MAIN FINDINGS ......................................................................................... 15 1. Cameroun ........................................................................................ 15 2. Tanzania ........................................................................................... 17 3. Chad ................................................................................................. 19 4. Uganda ............................................................................................. 21 CROSS-CUTTING ISSUES ............................................................................ 23 CONCLUDING COMMENTS ....................................................................... 25 PREAMBLE ......................................................................................... 27 INTRODUCTION ............................................................................... 29 METHODS .......................................................................................... 33 GENERAL METHODOLOGY ........................................................................ 33 Methodological approach ..................................................................... 33 Selection of cases .................................................................................. 33 MORE DETAILED INFORMATION CONCERNING THE CASE STUDIES ......... 36 LIMITATIONS OF THE STUDY ..................................................................... 39 THE CASE OF CAMEROON .............................................................. 43 GENERAL CONTEXT .................................................................................. 46 Introduction .......................................................................................... 46 Studies in HSO&P, 29, 2012 1 Place of the Church in the supply of care ............................................. 48 Partnership and contracting context at central level ............................. 50 Characteristics of the case selected ........................................................ 53 RESULTS OF THE INTERVIEWS AND THE ANALYSIS OF DOCUMENTS ......... 59 Contracting at central level: from dialogue to formalization ................ 59 Contracting at intermediate and peripheral level: the Tokombéré case .......................................................................................................... 64 CONCLUSION ............................................................................................ 71 THE CASE OF TANZANIA ................................................................. 75 GENERAL CONTEXT ................................................................................... 78 Introduction .......................................................................................... 78 Faith-based health sector in tanzania .................................................... 80 Partnership and contracting context at central level ............................. 82 Characteristics of the case selected ........................................................ 87 RESULT OF THE INTERVIEWS AND THE ANALYSIS OF DOCUMENTS ........... 93 Central level .......................................................................................... 93 Intermediate and peripheral level ....................................................... 100 CONCLUSION .......................................................................................... 105 THE CASE OF CHAD ....................................................................... 107 GENERAL CONTEXT ................................................................................ 110 Introduction ........................................................................................ 110 Place of the Church in the supply of care ........................................... 113 Partnership and contracting context at central level ........................... 118 Characteristics of the case selected ...................................................... 119 RESULT OF THE INTERVIEWS AND THE ANALYSIS OF DOCUMENTS ......... 121 Central level ........................................................................................ 121 Intermediate and peripheral levels ...................................................... 127 CONCLUSION .......................................................................................... 140 THE CASE OF UGANDA .................................................................. 143 GENERAL CONTEXT ................................................................................. 146 2 Studies in HSO&P, 29, 2012 Introduction ........................................................................................ 146 Place of the Church in the Supply of Care ......................................... 149 Partnership and Contracting context at Central Level ....................... 151 CHARACTERISTICS OF THE CASES SELECTED .......................................... 159 RESULTS OF THE INTERVIEWS AND THE ANALYSIS OF DOCUMENTS ...... 163 Central level ........................................................................................ 163 Peripheral level: St. Joseph Hospital, Kitgum ..................................... 169 Peripheral level: Kabarole Hospital, Fort-Portal ................................. 177 CONCLUSION .......................................................................................... 184 SUMMARY OF THE RESULTS ......................................................... 187 CROSS-CUTTING ANALYSIS AND DISCUSSION .......................... 207 CONCLUSIONS ................................................................................ 213 RECOMMENDATIONS .............................................................................. 213 STRATEGIC CONSIDERATIONS FOR THE FUTURE: WHAT ARE THE OPTIONS? ................................................................................................................ 221 REFERENCES.................................................................................... 227 LIST OF BOXES Box 1. The French debt relief program in Cameroon : HIPC and C2D ..... 52 Box 2. C2D Contracting terminology in Cameroon .................................... 57 Box 3. Faith-based hospitals in Tanzania : Voluntary Agencies (VAs) and District Designated Hospitals (DDH) ........................................................... 86 Studies in HSO&P, 29, 2012 3 LIST OF FIGURES Figure 1. Contracting process and Tokombéré contracting experiment in the overall context of Cameroon ......................................................................... 56 Figure 2. General C2D contracting process .................................................. 58 Figure 3. Number of hospitals by owner - continental Tanzania 2004-2005 82 Figure 4. Organisation of the Tanzanian health system ................................ 84 Figure 5. Karagwe district and health facilities .............................................. 89 Figure 6. Contracting process and Nyakahanga DDH contracting experiment in the overall context of Tanzania ................................................................. 90 Figure 7. Overall organisation of the Catholic health network in Chad .... 117 Figure 8. Contracting process and Moïssala contracting experiment in the overall context of Chad ............................................................................... 132 Figure 9. Distribution of the health facilities between the different coordinating PNFP organisations ................................................................ 150 Figure 10. Structure and division of income from financial contributions to the faith-based health sector. ....................................................................... 154 Figure 11. Health funding in Uganda. .......................................................
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