"Proselytism, contraception, gender, abortion, homosexuality". Go to most of the great multi-lateral agencies, the people with the money, to discuss faith communities' role in global health, and this probably forms the main conversation. Perhaps as the door is shutting, the World Health Organisation's estimate that throughout sub-Saharan Africa an average of 40% of the health care is done by faith communities might get a mention. Would that be something to think about?
Apart from knee-jerk reactions getting in the way of more pragmatic assessments, the problem is the classic one of stereotyping: lumping all faith communities together, taking the strident pronouncements and positions of a minority for the reality of the whole. The reality is that the reaction of the world's faith communities to the global scourge of HIV/AIDS has been outstanding: an holistic approach encompassing ending stigma, through prevention, education, palliative care, tending the dying, and care of orphans. It has revealed the potential and comparative advantage of faith-inspired health care. But the "story" ends up being about a handful of homophobic religious leaders and strident denunciations of barrier forms of contraception.
HIV/AIDS work is only the most recent global response of faith-inspired health care. From the late 19th Century faith communities have been providing medical care through clinics and hospitals. A more secular world view has changed their significance. I remember, at a non-religious school in the 1950s, having Lutheran Dr. Albert Schweitzer's hospital in Lambarene, Gabon, held up as a shining light on a hill.
The comparative invisibility of religiously motivated health care, in an age where the visibility of religious symbols - hijabs, crucifixes, minarets, turbans - is increasingly headline news, is telling. The "proselytism" claim suggests that this work is not understood for what it is: an expression of the compassionate core at the different faiths. But faith leaders can also be their own worst enemies.
This is also an age of statistics, evidence-based policy making, the need for transparency. Faith communities have not been a shining light in any of these. They are not on the map in Africa because they have failed to provide adequate data illustrating their work that governments and multi-laterals cannot ignore. In some cases they are literally not on the map.
They inadvertently, and sometimes deliberately, hide their light under a bushel. They have captive audiences for health messages and religious facilities way off the beaten track where less dedicated doctors, nurses and health officials are disinclined to go. Religious leaders give sermons and have a faith language to impart key messages.
The basic principles of Islam, the maqasids, place the preservation and health of the family very high in Muslim morality. The muezzin calls Muslims to prayer and falah - it is usually translated as success or as wellbeing. The theme of healing is amongst the basic themes of Christianity. So looking to faith communites for health care does not imply instrumentalising religions but living out their core precepts.
Alongside HIV/AIDS, in Sierra Leone, Nigeria and Mozambique there are now significant programmes of malaria prevention led by religious leaders and faith communities. They complement the work of malaria units in their countries' ministries of health. Religious leaders are trained and then in turn train senior and respected members of their communities. In a cascade effect, the latter undertake household visits delivering five core anti-malarial messages with the help of cartoons and dialogue with householders.
The spin-off is that in countries where inter-religious relations are fraught, different communities are brought together, converging around the common desire for health for their families. It is a convergence that can overcome the divisive qualities of religion manipulated for political advantage. It is also win-win as the religious leaders see the results of their endeavours in healthy children and their authority is augmented in the eyes of their communities, and often their governments. This is replicable.
The underlying question is this: if we set aside all the religious baggage, for and against but mainly against, of the movers and shakers in global health, and resort to prudential judgement instead of half-baked stereotypes, what would be a sensible way forward? We see African governments failing to provide the health systems that their populations deserve while getting the bulk of multilateral funding. We see, on the whole, a large parallel set of health assets run by faith communities which receive negligible amounts from these sources.
The creation of memoranda of understanding between governments and faith communities endeavouring to promote more integrated approaches is a start. But many of these go on the shelf shortly after being signed. Religious leaders need to be in upstream health planning. And they need to be transparent and accountable about their funding, document their work to a high standard, and get evidence of their effectiveness out in the public domain.
Where faith is working in the world• The Tony Blair Faith Foundation's Faiths Act programme has implemented a multi-faith health messaging programme in Sierra Leone. The country has 157 doctors to cater to a population of 6 million. Muslim and Christian leaders are trained together in key anti-malaria messages. They in turn train volunteers within their congregations s to conduct door to door visits, disseminating life-saving messages. In less than a year, the programme has reached more than 800, 000 households.
• The Nigerian Inter-Faith Action Association (NIFAA) has been working to equip faith leaders with the knowledge and tools to educate their communities in malaria prevention methods since 2009. According to World Bank data, bed net usage is more than twice as high in states where NIFAA is active. Evidence suggests that it is also cost-effective: each trained faith leader reaches approximately 700 people in total, the cost per beneficiary is only $0.07.
• Imams in Pakistan have helped the government and NGOs like UNICEF to dispel misconceptions around the polio vaccine, which is one of the few countries where it is still endemic. They have had a major impact in educating communities about the importance and effectiveness of the vaccination and public perceptions have changed.
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