Transcript Slide 1

Community Health –
Where do we go from here?
CCIH 2008 Annual Conference
W. Michael Smith, MAP International
Is this a ‘fullness of time’ moment?
Is God calling CCIH to specific role(s) at
this time?
Possibly some sequel to the role of CMC?
Many developments by/affecting Christian
agencies
• Religious health institutions provide 40 – 70% of
health services in many sub-Saharan African nations
• Major contributors in Primary Health Care movement,
Alma Ata (1978) and Peoples Health Assembly (2000)
• Promising models of comprehensive, community-based
health development
• Encouraging theological shifts yielding increased
energy among evangelically-minded - - spirit of Micah
Network
• Broader appreciation & engagement of FBOs
Dybul’s comments)
(Mark
Encouraging developments in global health:
• World seems more ready than ever to tackle the
diseases of poverty
• Foreign policy attention
• Unprecedented billions available for health
• 16% decline in estimated AIDS prevalence since 2006
(UNAIDS 2007)
• Surge of attention to Malaria & other neglected diseases
• 1990 – 2006 under-5 deaths declined from 13 to 10
million (World Bank’s Global Monitoring Report – 2008)
Deeply troubling health conditions:
• In 12 countries in sub-Saharan Africa, under-5 mortality
rates have increased, rather than decreased, since 1990.
World Bank’s Global Monitoring Report – 2008
• Only 16 of 68 countries where 97% of global under-5
deaths occur are on-track to achieve MDGs (Henry Perry –
5/24/08)
• Globally, over 1100 children die every hour, mostly of
preventable diseases and conditions
• Eighteen of the least developed countries, over 460
million, scored lower on Human Development Index in
2003 than in 1990; “an unprecedented reversal” Human
Development Report, 2005
• Life expectancy continues to fall – below 50 in some
countries
Complicating factors and Compromised Solutions
• Environmental and economic factors undermine already
fragile systems for survival
• Lack of coordination and a ‘dangerous deficiency in local
hospitals, clinics, labs, medical schools and health talent’,
makes it likely that ‘much of the cash now flooding the field
is leaking away without result.’ (Laurie Garrett, ‘The Challenge of
Global health” Foreign Affairs January/February 2007)
• Drain of health workers, e.g. 2000 – 2005, Malawi’s
government health system lost 53% of hospital
administrators, 64% of nurses, 85% of physicians, mostly
to NGOs & international agencies & institutions
• Costly bureaucracy and intervention models in the aid
industry
In the midst of these realities and perceptions,
we ask:
Where do we, CCIH, go from here?
Based on this conference, it seems…
The time is right for breakthrough efforts by Christian
agencies to demonstrate that:
holistic,
integrated,
community-based approaches to health development,
whose energy for change is self-empowerment,
offer hope for sustainable, comprehensive change
for communities in chronic cycles of poverty and
despair.
Holistic
By contrast, “Stove-piped” or vertical interventions
• Often provide intensive funding for important needs, e.g
ARVs, malaria
• May leave basic, general health needs unfunded
• 2006 President Clinton hoped HIV/AIDS programs would
help all other health initiatives
• Between 2002-2006, successfully provided ARVs to 5,000
needy Haitians - - HIV prevalence dropped from 6 to 3%
• But during same period “Haiti…went backward on every
other health indicator.” “The Challenge of Global Health”, Laurie
Garrett
HIV & AIDS - Illustrates the Integral Nature of Human Health
• Physically
- Ravages of disease, vulnerability
• Relationally
- Alienation from family, friends, neighbors
• Emotionally - Shame / stigma (two-edged sword)
• Economically - Can’t work
• Spiritually
- Those engaging promiscuity, unfaithfulness
- Those oppressing women & girls
- Powerless women & girls
- Despair
• Nutritionally - Can’t eat, can’t afford to feed family
• Educationally – Children can’t go to school
• Environmentally – No resources for preservation
• Cyclically/generationally - Children “cursed” for generations
Millennium Development Goals
1.
2.
3.
4.
5.
6.
7.
8.
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, TB, malaria and other diseases
Ensure environmental sustainability
Develop a Global Partnership for Development
9. Refuse culture of violence & unrestrained arms trade
The reality of
Social Determinants of Health
demands
holistic approaches
Community-based
“Solutions are in the communities” – Dr. Jack
Bryant 5/24/08
Authentically community – based
Swimming against the current of prevailing paradigm
of externally driven interventions
Our language reflects our struggle:
“Give power or dignity to communities”
“Community-based” is a belief first:
belief that local communities - especially those who
have lived in chronic poverty - have the inherent
strengths to author their own stories
- to rediscover their capacity to dream
- to learn to evaluate their situation
- to mobilize & organize the resources
- to take constructive steps to influence their world
- to evaluate and continue improving
Dr. Margaret Chan concluded her address to International
Federation of Red Cross and Red Crescent Societies –
Global Health and Care Forum 2008:
“Primary health care starts with people. Our common
humanity compels us to respect people’s universal
aspiration for a better life. It compels us to respect the
resilience and ingenuity of the human spirit, and the
great capacity of individuals and communities to solve
their own problems.”
If we believe that communities have the inherent
strengths to “author their own stories”, then
Communities don’t need us to:
• “give them dignity”
• “give them power or authority”
They already have it.
• Birthright as children of God
• Oppressed, stifled, beaten down – disempowered
• We helped teach them “poverty is their greatest
resource”
• Together we can be converted to the belief:
- Communities are partners & resources, not
targets
“Concept Note” from the Africa Regional Faith-Based Coalition (March
2008) expressed concern about:
“…a dominant culture of service-provision, intervention and
welfare is well-intentioned, but undermines the capacity of local
communities to acknowledge concerns, and act on shared vision
to respond to those behaviors that put them at risk. Technical and
organizational capacity development is often valued over Human
Capacity Development.
Human Capacity… describes the basic common human strengths
for care through accompaniment and participation, change, hope,
relational influence, and belonging. These are innate, but often
suppressed and need support to be unveiled.”
Empowerment
(cont.)
Finding the right language:
• “Self-empowerment” vs. we “empower” others
• Or “agency” - WHO article, February 2006, "What is
the evidence on effectiveness of empowerment to
improve health?", explained:
“Advocates or external change agents may
catalyze actions or help create spaces for people
to learn, but sustainability and empowerment
occur only as people create their own
momentum, gain their own skills, and advocate
for their own changes.”
Empowerment (cont.)
• Whether called agency or self-empowerment – It is
the energy for change (Locating the Energy for Change:
An Introduction to Appreciative Inquiry, 1999 C. Elliott)
• Sine qua non of sustainable, holistic health
development
• Research on definitions and indicators of
empowerment – Rollins School of Public Health,
Emory & MAP International
Five “I”s of Self-Empowerment
• Identity – Healthy spiritual and psychological
aspects of self-worth, self-esteem and selfconfidence
• Ideas – Ability to envision and dream alternative
futures
• Implementation – Capacity to act through
effective goal-setting, planning and the appropriate
knowledge, skills and tools
• Impact – Learning through monitoring and
evaluation
• Influence – Advocating for just and fair laws,
policies, systems and structures
MAP International
The time is right for Christian agencies to
demonstrate that… (holistic, community based approaches
bring greater help)
Evidence-based demonstration
• “We do good work. Trust us!” – not good enough
• “It has been difficult for NGOs to demonstrate the
worth and relevance of their work in a manner
acceptable to skeptical outsiders.” (Linda Kelly, Patrick
Kilby, and Nalini Kasynathan, “Impact Measurement for NGOs:
experiences from India and Sri Lanka”, in Development in Practice,
Vol. 14, Number 5, August 2004)
• Technical issues: measure impact or human process?
Qualitative and quantitative.
• Devise new paradigms & systems of M&E
Funding
Major funders more open to FBOs. Ironically:
• Sudden, massive funding could devastate CBPHC
• Feeding frenzy among NGOs
• Counter-productive flow of funds to programs
• Problem: Belief (funders & NGOs) that money is the
essential resource, the primary agent of change.
“This is a time to challenge that belief and operate from
a totally different perspective. Our view is rooted in the
spiritual transformation that renews their capacity to
solve their own problems.” Dr. Carl Taylor – 5/24/08
So our way forward must ask:
If the most-needed resource is communities who
have rediscovered and reengaged their capacity to
dream and to author their own story,
what mechanisms, processes, criteria are needed to
find and invest resources in ways that enhance
rather poison that most-needed resource?
Confidently Christian
Wellspring of self-empowerment –
• Self-respect & mutual respect from deep
encounter with God’s love gives birth to hope.
• Spirit of Life in Christ Jesus = “energy for change”
• Relentless in our ministry with the poor –
“Unconditional love” – Paul Freeman
• There is such an “inextricable link between health
and social justice” that Dr. William Foege, has said
that “public health is the secular arm of theology”.
(Deborah McFarland, Rollins School of Public Health, Emory
University, “Clanging Symbols”)
Engage churches as partners in new vision of
“…thy will be done on earth as in heaven.”
Instead of traditional, dualistic view (church deals with
spiritual matters, others deal with physical needs),
rediscover the gospel of the Kingdom of God.
You know it is a Christian congregation because:
• Blind receive their sight
• Lame walk
• Lepers are cleansed
• Poor have good news preached to them
Christian congregation as outpost and agent of the
comprehensive shalom which is the presence of the
Kingdom
• Lawndale Community Church
So, to our question
Echoes of Moses…
This is the time…
• To go beyond the “low-hanging fruit” (Dr. Carl
Taylor, 5/24/08)
• For a “radical break” (Dr. Carl Taylor, 5/24/08)
• “We have a great opportunity for new thought about
global health. The faith community as a whole can
begin to take leadership that we have not taken.”
Only that day dawns for which we are awake
Henry David Thoreau