The View from Above: Faith and Health

"At the national level, faith-inspired health providers deliver health care in many contexts. Internationally, faith affects and shapes development agendas and responses to poverty and inequity. However, faith factors are not always taken into account in public health discourses. "

From The Lancet series on faith-based health care, this overview describes the range of care of faith-based organisations (FBOs) and their influence and provides suggestions on developing their contribution to improve health outcomes. The authors found that classifications of faith-based organisations and records of their work presented challenges. Organisations range from large transnationals such as Catholic Relief Services to diffuse and much less visible local FBOs. Their work can include, for example, "coordination of several health and social services and offer of a more holistic approach to care that includes not only a person's physical ailment but also the social and communal context and spiritual dimensions of wellbeing."

Papers in the series point to the magnitude of care and range of quality of care and the ability to serve hard-to-reach populations and prioritise economically poor and marginalised people and to mobilise volunteers, as well as to innovate in fee structuring and governance approaches. Drawing on existing research, the authors look at the importance of FBOs to lower-middle-income country health systems.

Debates are examined in some of the papers, for example, the religious advocacy that might be antithetical to human rights. "[A]spects of gender, sexual and reproductive health, reproductive rights, family planning (especially contraception), violence against women, and resistance to some vaccinations..." can be affected by faith-based ethics, behaviours, and attitudes such that inequalities are exacerbated, such as "prevent[ing] women; young girls; and lesbian, gay, bisexual, and transgender people from accessing health services."

"In terms of worldwide dynamics around international development and health, substantial consequences exist for health and the work of faith-based actors in health delivery." Violence and political instability contribute to weak institutions and negatively affect health service provision, sometimes endangering - even targeting - health workers. At the same time, "[f]inancing and work-force dynamics are also driven by substantial global health funding by multilateral organisations"; yet, though funding can strengthen health systems and health innovation, it can contribute to uncertainty in care, payment, and coordination, among other results, and cause competition for resources. Reliance on women of faith to volunteer can be exploitative and make services less reliable and professional.

Further, religious concerns are linked with the tensions "between elements of human rights discourse and rights-based development praxis, on the one hand, and cultural considerations mixed with national sovereignty to establish governments' own priorities, on the other....With this in mind, an informed appreciation of the highly complex nexus of faith and health-care delivery and engagement becomes a strategic necessity and a tactical advantage."