link between the Government and REs at the national and district levels.107 It was also noted that government appreciates the contribution and efforts of the REs to health and well being of communities. The following quote on the perception of FBOs contribution to health captures the spirit of appreciation of REs services
‗World Vision had a very positive view of the role of FBOs providing health services. One of the differences identified between government and FBO health facilities was the quality of care and especially the trust in individual health workers that patients had developed, as well as the long-standing name of a facility as being a place of good care over the years.‘108
The appreciation by the government of the involvement of REs in health provision is publicly illustrated in the National HIV and AIDS policy. 109 The involvement and appreciation of religious health institutions in health services in the country become more prominent during the decline of government health services (as noted above) This situation created a platform for the religious health institutions‘ contribution to health to become more prominent and appreciated by Government even in policy matters. The research also found some common constraints and challenges among the FBOs in the area of inadequate funding, shortages of skilled and qualified staff, especially in rural areas.
ARHAP conceptual framework of Religious Health Assets (RHAs) suggests that there are two basic kinds of religious health assets namely, tangible and intangible assets. These RHAs contribute to direct and indirect health outcomes.
The Theory Matrix is developed in a manner that provides a tool to assess religious assets and how they impact on health outcomes. The matrix illustrates possible avenues showing how religious health assets interplay at various levels such as the intangible and the tangible religious health assets and how they function and impact on health in either direct or indirect outcomes. It is important to understand that this theory matrix has at this stage only been proposed and ARHAP is undertaking field research to clarify and develop the theory. The research in this thesis is part of the process of evaluating the understanding and contribution of religious assets to health outcomes. Therefore, while this research assumes this theoretical framework as its starting point, its findings may also lead to the further development of the same framework.
The matrix as shown below has the following four quadrants comprising:
1 Tangible religious assets and their Direct health outcomes 2 Intangible religious assets and their Direct health outcomes 3 Tangible religious assets and their Indirect health outcomes 4 Intangible religious assets and their Indirect health outcomes
ARHAP THEORY MATRIX110 Figure3.
Intangible religious assets
Possible factors include: 1
Prayer Resilience
Health seeking behaviour Motivation
Responsibility
Commitment/sense of duty Relationship: care giver and
‗patient‘
Advocacy/prophetic Resistance- physical and or structural/political
Possible factors include: 2
Individual (sense of meaning) Belonging-Human/Divine Access to power and energy Trust /distrust
Faith-hope-love
Sacred place in a polluting world Time
Emplotment (story)
Tangible religious assets
Possible factors include: 3
Infrastructure Hospitals-Beds etc Clinics
Dispensaries
Training and Para- Medical Hospices
Funding/development agencies Holistic support
Hospital chaplains Faith healers Traditional healers Care Groups NGO/FBO- ―projects‖
Possible factors include: 4
Manyano and other fellowships Choir
Education Sacraments/rituals
Rites of passage( accompanying) Funerals
Network/connections Leadership skills
Presence in the Bundu (on the margins) Boundaries( Normative)
Direct health outcome Indirect health outcome
3.6.1 Tangible and intangible religious health assets and their direct and indirect health outcomes.
The ARHAP matrix presents two ‗forms‘ of religious health assets, namely tangible and intangible and how these assets impact on health outcome directly or indirectly on the well being of people and communities. These assets show how faith based or religious health activities and institutions respond to health challenges.
110 James Cochrane and Barbara Schmid, ARHAP Tools Workshop Report. (Cape Town, June 6-8, 2004) Available from ARHAP offices, UCT.
3.6.2 Tangible Religious Assets and their direct and indirect health outcomes.
Looking at the matrix in quadrants 3 and 4 we have tangible religious assets. These are visible structures and activities operated by religious health institutions, individuals and/or Faith Based Organizations (FBOs) which are religious in nature and practice. These would include health institutions, mission hospitals, clinics, care groups, hospices, dispensaries, and health networks.
These activities affect the health outcomes in a tangible or visible manner. They enhance health outcomes directly or indirectly. Religious health activities, such as conducting healing sessions, FBOs that run health institutions such as hospitals, clinics, health care groups and hospices are classified as tangible RHAs in the ARHAP theory matrix.
An example of indirect outcome would be activities such as fellowship that takes place in the church among different age and sex groups, Christian education on lifestyle and moral behavior, fellowship and support in times of the joys and difficulties, support received during funerals. In the church set up activities such as the presence of unity and family found around sacraments as the Lords supper and other communal rituals. These religious assets may not directly focused on health and healing, but eventually contribute to the well being of people and communities.
Cochrane makes an important observation and comment on the role RHAs when he says;
Existing literature on FBOs concentrates on hospitals, clinics, and other visible facilities accounted for in national public health systems that are either run by or funded by religious bodies. No-one has a sense of their combined scale and contribution to public health, and they often go unrecognized. Even when recognized, they are likely to be misunderstood, sometimes overestimated, and sometimes undervalued in terms of their contribution to health.111
Cochrane also notes that in response to the HIV and AIDS pandemic 30% to 70% of organizations involved in the response to the pandemic are FBOs.112 These tangible religious assets contribute to health in a direct manner visible to the human eye. They often transcend the ordinary public health provision as they engage assets that are religious and comprehensive in nature and practice having direct health outcomes.
111 James Cochrane, Religion, Public Health and a Church for the 21st Century. ARHAP Article, 2006 p9
112 James Cochrane, Religion, Public Health and a Church for the 21st Century. ARHAP Article, 2006.
3.6.3 Intangible Religious Health Assets and their direct and indirect health outcomes In quadrants 1 and 2 of the ARHAP matrix, a second set of religious health assets are identified, as intangible assets these are not visible structures such as mission hospitals, clinic dispensaries and hospices. They are labeled as an intangible or invisible component of religious health assets, which operates at the unseen or invisible level. Conventional health care providers rarely appreciate these intangible assets because they cannot be quantified scientifically in health care provision. These would include activities such as prayer, support groups, faith, hope, motivation, trust, love and all other invisible qualities, which contribute to the well being of individuals and communities.
These intangible religious activities create a positive component to those seeking for health and healing. It is this missing or neglected dimension of human health seeking component found in intangible RHAs, which provides resilience and power to withstand sickness and harsh conditions. Intangible RHAs are activities such as praying and anointing the sick for healing, advocacy or prophetic ministry speaking against vices that dehumanize people and encouraging the sick to keep hoping for the best in times of affliction.
In addition to this, the matrix also present intangible religious assets and their indirect health outcomes. These outcomes impact on the well being of people as indicated in quadrant 2 of theory matrix. In this quadrant the matrix shows important elements such as the core value and meaning of life and the need for people to belong to a community or church family. In these communities, people derive encouragement through shared life experiences. It is argued that all these assets, though not measurable, contribute to better health outcomes in and indirect way.
3.7 Research findings from Zambia and Lesotho, which strengthen the ARHAP