The provision of health services in most developing countries includes two distinct forms of funding -- public and private sector. Governments provide public funding for services, develop health policies, and regulate the provision of services. In addition, it is estimated that 40% of health services are funded by Non-Governmental Organizations (NGOs) in the private sector.

Christian missions (or church-related agencies) are the most important segment of the NGO movement. By Christian missions, we mean local, developing country churches and organizations serving their fellow citizens as well as international NGOs, often headquartered in industrialized countries.  They represent a major health lifeline in international public health which, in this article, is defined as the provision of population-based health services in developing countries. Christian missions often provide health services in the remotest hamlets and villages of the world where government or public sector services are often non-existent.

As we move into the 21st Century, the role of Christian health missions will become even more important for two reasons. First, many governments are privatizing, at least partially, the delivery of health services. Second, there is an increasing role of market forces driving the development of health systems.

With this context in mind, here are my suggestions for ten key roles by Christian health missions in international public health.

1) Provide Health Services to the Poorest of the Poor:
Christian health missions will continue to provide essential health services to indigent populations, especially those that do not have access to other health services because of geographic or economic isolation, social unrest, political crises, or dwindling governmental funding.

2) Manage Population-based Health Services:
Christian missions should focus on geographically defined populations in order to be responsive to the cultural dispositions and practices. Population-based planning also provides a denominator to monitor activities and a means of coordination so as not to duplicate services provided by other health service providers.
 
3) Involve Communities in Health Programs:
Christian health missions should increase the participation of target groups in identifying health priorities as well as in the management, monitoring, and evaluation of health services. Community involvement should go beyond the role of "Parish Councils," selected "Laity," and "Deacons" to include all individuals and community representatives.

6) Link Health with Women's Development:
Until the expansion of public education, most women in developing countries had their education in mission schools. Educated women have a far better chance of living longer and having successful and fewer pregnancies. Six years of education correlates with reduced risk of dying during childbirth or infant mortality. Despite these positive results, women continue to have problems with access to health services, staying in school, becoming economically self-reliant, participating in the political process, and owning property. Christian missions should continue to emphasize female education and economic opportunities for women in promoting the fiscal health of their families and communities.

7) Focus on Moral and Spiritual Mores of Teenagers:
Every society must deal with the angst of the teenage years -- the development of an identity and skills that help them become independent. However, the traditional family system is under attack by poverty, mismanagement of public resources, and the unrelenting march of diseases such as HIV/AIDS. Street children of Brazil and the boy soldier of Liberia are common staples of daily news. Children are often enticed into involvement with street gangs, pimps, and criminal activities. Christian missions have the moral and spiritual authority to reach troubled teens by devoting time and resources to teenage issues, especially uninterrupted education and preventive health services.

8) Develop Sound Ecumenical Health Programs: '
Interfaith health systems are built on the principle that Christian-managed health systems accept clients of all faiths while retaining their  fundamental Christian beliefs. This apparent contradiction of "practicing" ecumenism while "observing" fundamentalist belief is the basis of all interactions between major religious groups. Christian missions need to recognize that other religions have health missions  similar to their own. Christian health missions should seek strategic alliances with other religious groups who may have a greater influence among the local population. These strategic alliances should focus on coordination of resources, collaboration on socioeconomic issues, and the mobilization of target communities toward specific objectives.

9) Exchange Lessons Learned:
Many Christian health missions are familiar with the health systems of more than one country. Actually, there is little difference between poor populations of developed and developing societies. They both operate outside the mainstream political, economic, and social systems. Because of these similarities, a formalized process of exchanging lessons learned between developing countries and between developing and industrialized countries could become an important activity of Christian health missions. The National Council for International Health (NCIH) calls this "Lessons without Borders." For example, experiences of urban America health missions in working with inner city populations may be applicable for community-based activities in developing countries. Likewise, fiscal expertise of larger Christian health missions could help smaller NGOs improve their management of limited resources to serve far more clients. On the other hand, industrialized countries could benefit from the successful immunization strategies of Christian health missions in developing countries.

10) Link Health with Self-Determination:
Communities which are denied self-determination and participation in the political process will inevitably rebel. This leads to political unrest, economic instability, and disruption of health systems, including those managed by Christian health missions. It is no secret that countries with thriving democracies enjoy the best health status worldwide. Christian health missions, without choosing sides in political ideologies, should promote population-based self-determination to organize themselves and participate in the political process. This empowering process helps communities take charge of their lives and their health status. Unfortunately, collaboration between Christian missions and governments can impede self-determination. Christian health missions should avoid becoming involved in the "internal national" issues of their host countries, and focus on community empowerment. Ultimately, individuals of each country will determine their own political destiny.

In conclusion, as we move into the 21st Century, NGOs will continue to play a critical role in the provision of health services to indigent populations. The most successful and powerful NGOs include religious health agencies, mostly Christian health missions. Christian health missions should review their current strategies and realign them, according to health and non-health forces that are shaping international public health. Christian health missions have a major strategic advantage and responsibility in shaping international public health. Their focus on the poor, the infirm, the disabled, and the disenfranchised segments of society, will continue to invoke the imaginations and encourage the work of health planners and providers around the world.
 

The Bibliography for this Article: