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Submitted by Quentin on

Thanks much Katherine for your comments and suggestions.

I fully agree that there are substantial differences in the role of faith-inspired healthcare providers between countries. The Christian Health Associations (CHAs) for example have a strong presence in many Anglophone countries, and a smaller footprint – when they exist – in much of Francophone Africa, and this is related in part to the legacy of the colonial heritage. Within Anglophone Africa, there are also large differences, not only in market share, reach to the poor, cost, and satisfaction, but also in terms of the recognition granted to faith-inspired providers by government. Ghana stands out as one of the countries where the partnership between the CHA and the government is strong. As you point out there are also differences between faith traditions, and we know much less about Islamic providers than Christian ones. Finally, you note that faith-inspired healthcare providers are a heterogeneous group – with some providing service of great quality and others less so. It is to provide such context that our three volumes study combines multi-country analysis with detailed country case studies.

In terms of future agenda, all the points you mention are clearly worth pursuing. I would like to add three more. First, as I mentioned it to my reply to Shanta, if we want to operationalize this work, we really need to understand better why some faith-inspired providers do so well, so that others can learn from their experience. What’s in the black box? Apart from intrinsic motivation, what are the systems and management mechanisms that foster a culture of service among these providers? Second, faith leaders have a strong influence on the population’s behaviors, including health-related behaviors or behaviors with health consequences. We need to try to better harness this influence for improving health outcomes. Third and finally, we need to better understand the role of small informal faith-inspired initiatives from congregations and other community groups. While we have made progress in understanding the role of larger facilities-based faith-inspired healthcare, we still know little about small-scale and faith-inspired informal providers of care and healing.