“Faith based organizations” are responsible for 30 to 70% of the health infrastructure in Sub Saharan Africa. LINK

There is a secret known to many of us who attend church and who donate money to fund missions and missionaries in Africa: the fact that much of the rural health care in sub Saharan Africa is run by “faith based organizations”, including many of the centers that dispense and care for HIV positive persons.
The reason that this needs to be remembered is that many of the highly publicized and government run initiatives may ignore these longstanding organizations in favor of NGO’s that are more widely known in the west, but whose philosophy may not be compatible with African or faith based morality.

Let’s start with the basics.

The term “faith based organizations” is for church hospitals, clinics, and public health outreach centers run by people associated with religion. But technically, they may not be “church” owned, so they can’t use the term “church hospital”.

For example, our mission hospital in rural Africa was owned by the religious order of nuns that ran it. But the land was owned by the diocese (Catholic church), and the salaries and construction costs were a grant from the government, and many of our outreach programs, such as the Nutrition village for malnourished but not sick children, or our village health workers, and our baby clinic/immunization clinics and our well digging initiative were funded from various sources, including Oxfam, World Vision, private money donated to the sisters, and government grants. Even my job as a doctor was sponsored by a non church NGO in the USA, my airfare paid by German charities, and my salary paid for by the government.
Such arrangements are common in Africa.

The picture of missionaries in Africa by those living outside that continent is alas influenced by Hollywood. So we either see sad faced bigoted white supremists teaching the native, or Angela Joilie being the great white mama doc who treats the poor people.

Well, even when I was there 30 years ago, this was out of date. Most of our nurses and nuns were local women, with only a few German nuns working side by side with them. The lectures and public health outreach was done by our local nurses, who could speak the dialect and knew the customs. You see, without the trust of the local people, you just don’t give a shot like MMR (measles mumps rubella) that can cause a high fever. And without the trust of the local people, giving out birth control pills or shots can lead to suspicion of genocide.

Does this sound extreme? Well, just today we hear that the Taliban has killed a local Pakistani doctor working in the tribal areas of NW Pakistan. His crime? Giving vaccinations to prevent Polio.
You see, to get the trust of people, you have to respect them and love them, and understand them and their own beliefs, whether it be eradicating polio in Bengal with the assistance of local Hindu priests, running a wound healing program among Diabetic Chippewa in northern Minnesota, or giving family planning to African women where having children is seen as a means to increased status in the eyes of her family. Without such understanding, and without the use of the local people, you just are viewed with suspicion.

Indeed, the importance of using faith based organizations is why two widely assumed ideas about HIV aid are not completely true.

One is that only government aid counts. You often read that the US lags behind some European countries in development aid. Well, that is because these surveys only include formal aid of one government to another. By ignoring faith based health care, and by ignoring private donations (i.e. anything from my mother’s five dollars sent to Catholic sisters in Africa to the Gates Foundation) this allows some people to bash America as stingy, while also promoting the idea that only solution is a large bureaucratic monopoly, preferably run by the UN. Yes, UNICEF and WHO do great work, but they would be the first to point out the need o support local grass roots and faith based structures).

The second reason to be aware that much health care is faith based is morality. Africa is morally old fashioned (i.e. traditional). Many of the western NGO’s, especially those that promote HIV education, inadvertantly promote a western approach to sexuality, including homosexuality, abortion, and freedom for girls to be sexually active.

Whether or not you agree with these agendas, what you need to know is that such behavior in a poor society has devestating consequences, in many ways. The most important thing to remember is that there is no social umbrella for sick or pregnant individuals outside the family.

I have argued elsewhere that the Asian approach, to have NGO’s target specific groups (i.e. sex workers, drug addicts) and then let government and churches that disapprove of such behavior promote the general moral consensus in their programs can be a successful strategy.

Indeed, this is why criticism of Bush’s funding decisions for Africa and HIV is short sighted. Not funding abortion promoting family planning clinics in countries where abortion, albeit widespread, is considered murder, or the emphasis on abstinence that revives the morality of the elders can decrease the percentage of promiscuity. You simply don’t want the Amerrican government to be branded as promoting immorality. And since there are lots of rich philanthropists who fund Planned Parenthood and other private NGO’s to do the “dirty work”, a dual approach is more useful in the long run.
Cross cultural medicine requires a sensitivity to the beliefs of locals. Africans may be traditional, Christian or Muslim, but without recognizing their belief systems and working with them (or around them) is how public health is done.

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Nancy Reyes is a retired physician who lives in the rural Philippines with her husband. She has worked as a doctor in Africa and with Native Americans in the United States. Her webpage is Finest Kind Clinic and Fishmarket, and she posts longer medical essays to Hey Doc Xanga Blog.

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