CRS, CHA to bolster health care in emerging economies

April 1, 2012

Assembly session to detail how CHA members can get involved in new initiative


In many developing countries, religious communities and other faith-based providers have been successful in establishing a basic level of health care services for the poor. But many of these providers lack the resources and expertise needed to expand their capacity and to make a bigger dent in the health problems plaguing the poor.

Baltimore-based Catholic Relief Services plans to aid some of these health care providers through a 10-year, multimillion dollar collaboration with CHA, the University of Notre Dame and others called "Strengthening Faith-Based Health Systems." Through the initiative, CRS will channel its own resources and those of its partners — including funds, technical expertise and staff — to faith-based health care facilities in 10 developing countries so that they can "scale up" and provide more effective services. Many of the facilities to be aided by the effort will be Catholic; some may be of other denominations, potentially protestant and Muslim.

To bolster these health care providers, CRS and its partners will work with them in their local communities, helping them to assess the unmet needs, make plans for meeting those needs, secure government buy-in and aid for their work, connect with other faith-based providers to achieve more influence, improve their fund-raising activity and improve some of the infrastructure they're working with, such as their computer systems.

"It's a wonderful opportunity for Catholic organizations (in developing countries) to work together to make a bigger impact on health care" in the developing world, said Michele Broemmelsiek, global chief of party for CRS' AIDSRelief Consortium. She and colleague Shannon Senefeld, global director of health and HIV services, will formally launch Strengthening Faith-Based Health Systems at an Innovation Forum session at the Catholic Health Assembly June 3-5 in Philadelphia. The session is a curtain-raiser for the post-assembly 2012 Global Health Summit taking place June 5 at the same venue.

CRS and CHA now are determining the 10 countries they will target; CRS will announce the countries at the assembly session.

Resource crunch
Broemmelsiek said that while the specific histories and setup of different faith-based providers vary by country and by facility, in general, faith-based groups established their facilities in developing countries by dispatching small teams of their congregants to foreign countries to start hospitals, clinics or other health care sites. Over time, much of the day-to-day health care came to be provided by citizens of host nations, generally with ongoing support from the founding sponsors. But, securing sufficient ongoing support has become a challenge, as congregations' ranks have decreased and budgets tightened, explained Broemmelsiek.

In some developing countries, the government health department provides payments or subsidies to the hospitals; in some, patients pay some fees; and in some, donors from the developing world provide funds. But, the funding streams are more like a trickle in many hospitals. "It's a huge challenge to keep operating" these faith-based facilities, which, in many cases provide the primary or sole source of health care outreach to the poor, said Broemmelsiek.

And the needs are extensive. According to 2009 statistics from the World Health Organization, worldwide, there were more than 33 million people living with HIV that year, 9.4 million new tuberculosis cases, and 225 million people with malaria, with many such diseases concentrated in low-income countries. Conditions like respiratory infections and diarrheal disease that are easily treated in developed countries are leading causes of death in the developing world, according to CRS.

CRS has a long history working with faith-based health care facilities and others in developing nations including Haiti, Kenya, Nigeria and Zambia. The in-country providers that CRS champions often lack the resources to look at the health needs broadly, proactively and systematically, said Broemmelsiek. Strengthening Faith-Based Health Systems will help move them in that direction.

Built on existing foundation
Plans call for CRS to focus first on countries in which it already has relationships with Catholic and other faith-based facilities and in which there already is the capacity to scale up to more effectively provide services.

CRS plans to engage its own staff as well as health care experts in the Catholic health ministry and research experts at Notre Dame in the on-the-ground work in each country. The in-country team will work with faith-based health care facilities — mostly Catholic facilities — to assess public health needs and respond to them strategically, including by:

  • Enhancing the relationships among the faith-based facilities, so they can work together.
  • Helping these linked facilities to achieve "economies of scale" so they can wield greater influence when negotiating with government departments, vendors and others.
  • Training in-country health care providers on how to assess and respond to health needs to achieve specific goals and health targets. This includes project planning and formal monitoring and evaluating projects to assess their impact.
  • Providing credentialing and course work to improve caregivers' health care skills.
  • Helping put in place infrastructure needed to be more effective in advancing public health goals, including information technology systems.

Summoning resources
CRS hopes to attract the funding and other support needed to carry out this approach in each of the 10 countries from CHA members, other Catholic organizations, private foundations, corporations and the U.S. government.

It also hopes to involve its core partners — CHA and Notre Dame — in providing their expertise to the CRS and the faith-based facilities in-country as the initiative rolls out.

CRS, CHA and Notre Dame are in discussions now to finalize plans and secure buy-in from their staffs or members as the case may be prior to the official launch at the assembly session. Broemmelsiek and CHA's Bruce Compton said initial discussions with CHA members and other potential partners have been promising. Compton is CHA senior director of international outreach.

Broemmelsiek said CRS' experience will be put to good use in Strengthening Faith-Based Health Systems. For the past eight years, CRS has coordinated the AIDSRelief antiretroviral therapy program in 10 countries, working with nearly 700,000 clients at 275 facilities. (The project's funding came from the President's Emergency Plan for AIDSRelief through the Health Resources and Services Administration. In recent years, PEPFAR has shifted focus from scaling up to sustaining its work through a country-led response, and so AIDSRelief recently transitioned management of the antiretroviral program to in-country partners, who are now direct recipients of PEPFAR funding. In some countries, CRS continues to receive PEPFAR funds to support its partners.)

Senefeld added that in the past, when working on smaller-scale partnerships with U.S. Catholic health care providers, CRS has sensed that "there are untapped resources among U.S. Catholic health care providers, and that there is a capacity and willingness (by these providers) to be engaged" in global efforts. Senefeld cited earthquake disaster relief in Haiti, noting that dozens of ministry members have helped provide large-scale support to rebuilding the health system there.

Compton noted, "So often, CHA and CRS have been doing this type of work in parallel — but now this would be a more coordinated effort."

"It's an exciting opportunity for engagement," added Senefeld.

Post-assembly session on global health care

The Catholic Relief Services Innovation Forum session at the Catholic Health Assembly is also part of the second annual Global Summit, a daylong program that starts June 5, on the closing day of the assembly in Philadelphia. One need not attend the assembly to register for the summit.

The summit will emphasize how the ministry can enhance its work in international aid.

Speakers involved in international ministry — including CHA members, CHA staff and CRS staff — will describe how and why the Catholic health ministry is helping people in need in the developing world, including explaining the rationale behind various members' approaches and the challenges they face in carrying out their work. Other speakers will focus on best practices by medical supply processors managing a supply chain that starts with donations from U.S. hospitals and ends with practical repurposing of equipment and materials in facilities in the developing world. The meeting will include an update on relief efforts in Haiti.

A U.S. government representative connected with the U.S. Global Health Initiative will describe U.S. policies on global aid and will explain how the government is working to improve the efficiency and effectiveness of international aid.

Key components of a 'healthy' health system, according to WHO

The World Health Organization has defined what well-functioning health systems look like, and CRS will use this definition when undertaking the Strengthening Faith-Based Health Systems initiative.

WHO says a "healthy" health care system responds to a population's needs and expectations by:

  • Improving the health status of individuals, families and communities.
  • Defending the population against health threats.
  • Protecting people against the financial consequences of ill health.
  • Providing equitable access to people-centered care.
  • Making it possible for people to participate in decisions affecting their health and the health system.

WHO says the following "building blocks" must be stable for a health system to function well. These blocks include:

  • Leadership and governance
  • Health information systems
  • Health financing
  • Human resources for health
  • Essential medical products and technologies
  • Service delivery channels


Planned steps for undertaking the initiative

To implement Strengthening Faith-Based Health Systems, CRS and its partners plan to:

  • Identify each of the 10 target countries (CRS).
  • Complete an in-country assessment for each (CRS).
  • Determine the scope of work needed and secure assistance from its core partners (CRS).
  • Identify who in the partner organizations can complete the work needed in each country (core partners).
  • Organize the work (core partners).
  • Complete the work.


Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.