Africa’s untapped resource.The importance of Church based networks in Africa.

IntroductionSince this website (http://ministryofsafety.wordpress.com/) is dedicated to serve Africa, this document will focus on that Continent, although much of what is said here may apply elsewhere.

Christian churches and Muslim communities in Africa continue to grow and flourish. It is not the purpose of this paper to discuss why this is happening but to try to understand if these powerful communities can be harnessed for the greater good of their societies. For example, can it be demonstrated that activities such as road safety can be improved through church and community participation in safety programmes?

In the West, institutions governing welfare, education and safety are well funded by the population and management of them has been devolved to government. The infrastructure is well maintained and healthcare is generally available to all. The standard of living is reflected in the life expectancies of the population1. This is not the case in Africa where much of the welfare is down to the family unit.

The World view of the West is quite different from the world view of Africa. Perhaps one of the most significant differences is in relation to family and community. African society “stresses more the importance of the community/family than the individual. Herewith is the emphasis on the constitutive factors of the community and especially, those which bind the individuals together in the unity of the community” (Dr. Chibueze C. Udeani, University of Salzburg). Families are extended such that very distance relatives remain part of the family or clan.

The materialistic western society has no need of an extended family as its welfare is focused in the state institutions. Africa does not have this luxury and consequently, the family and community are essential lifelines for well being.

The Western society is unlikely to empathise with some of the culture in Africa because it has become a secular society. It is also quite cynical about the sincerity of the religious communities when it observes the disconnect between religious belief and the failure to live up to the values of those beliefs, especially visible in the levels of corruption across societies. For this reason, there may be suspicion about the value of using churches in safety programmes.

It is the purpose of this paper to show that not only do churches and communities have a role to play in road casualty reduction and that they also may be the major factor in social improvements and social reforms in Africa.

It may be time to stop trying to Westernise Africa and instead, reinforce the cultural norms, identities and communities that make it special.

1 Life expectancies in the United Kingdom in 1900 were 47 years for a male and 50 years for a female, similar to many countries in Africa today. Life expectancy in the UK is now 77.9 years for men and 82 years for women but in poor areas it falls to 75.8 and 80.4 years.

The Western disconnectWestern society is secular and religious attendance in Christian countries is declining. Weekly religious attendance in the European Union struggles to reach 30% (predominantly Catholic) and is as low as 10%.

The United States is slightly higher, with the major attendance occurring in the southern predominantly protestant “Bible belt”.

An international Gallup Poll, (http://www.gallup.com/home.aspx) asked a broad question: "Is religion important in your daily life?" the "yes" and "no" answers are represented below. Africa was by far the most religious continent on the planet. This covers both Christian and Islamic traditions.

The survey revealed that out of the 56 countries in the world where the population gave a positive (yes) response, totalling over 90%, 33 of those 56 countries were in Africa.

The distribution of Christianity can be seen below (source: Operation World http://www.operationworld.org/ ). It is assumed that the lower percentage “Christian” tradition countries will have the remaining population in the Islamic tradition.

The African faith traditions are potentially a huge network for the distribution for both information and training (not just road safety), that remains largely untapped.

Churches as NetworksUsing church networks have several precedents. A number of studies have been conducted concerning the benefits of using church networks to devolve social programmes.

Case Study 1

African American Church Participation and Health Care Practices2

This study explored the relationship between church participation and health care practices in a large, African-American, low-income community.

Data was collected during a neighbourhood survey to identify and recruit adults with high blood pressure to participate in a community-based trial to improve high blood pressure care and control, in an inner-city African-American community. All adults 18 years of age and older were eligible for the survey. The survey used a stratified sampling method that divided the neighbourhood into 3 districts. Surveyors canvassed the neighbourhood during daytime, evening and weekend hours, to enter functioning households. Almost half of the households that were eligible to be interviewed were accessed by interviewers.

The survey included socio-demographic information and a general health interview. The socio-demographic information included age, gender, educational attainment, employment status, marital status, and church attendance. The general health interview survey assessed perceived health status, morbidity, health care utilization, and health insurance.

In an African-American, low-income community, about one third of the residents attend church regularly. Church attendance was associated with multiple positive health care practices. Those who attended church were 20% to 80% more likely to report practices such as mammogram, blood pressure measurements, and dental visits than their counterparts who did not attend church. Even after socio-demographic characteristics were taken into account, church attendance continued to be associated with modest and large increases in some practices. Moreover, even when there was no important overall benefit, church attendance was very important for some subpopulations. For high-risk groups, such as the uninsured or the chronically ill, church status was importantly associated to whether a respondent received a Pap smear or experienced no delays in care. The effect of church attendance was equivalent to or more important than most traditional socio-demographic and economic variables, except for insurance status or a regular source of care.

This study suggests that attendance at church may improve the health status of urban African Americans by increasing the likelihood of preventive health practices. Importantly, this benefit is particularly observed among those most in need—the uninsured and chronically ill. Our study has several important policy implications. First, public health programs that aim to reach low-income residents may be strengthened through collaboration with churches. The church may extend the reach of these programs to church attendees. These programs could also build on the church’s traditional commitment to reach out to non-attendees, the community outside its congregation, by 2 African American Church Participation and Health Care Practices Kaytura Felix Aaron, MD, David Levine, MD, ScD, Helen R. Burstin, MD, MPH J GEN INTERN MED 2003; 18:908–913.

using lay health workers in these partnerships. This model could help extend the health benefits seen within the church to non-congregants. This study suggests that religious involvement confers survival benefits to participants by improving health care practices.

Case study 2

Church Partnership Program, Papua New Guinea3

This case study is one of five activities evaluated to inform the Office of Development (ODE) evaluation of the Australian Agency for International Development’s (AusAID’s) engagement with civil society. This case study evaluates the relevance and effectiveness of the Church Partnership Program (CPP) in Papua New Guinea (PNG) in order to provide detailed evidence on AusAID’s engagement with civil society in the context of PNG.

Different contexts and modalities, and means of engagement were selected for the five case studies across three countries. With Human Development Index rankings comparable to Sub-Saharan Africa, the PNG context is highly challenging. It is geographically and culturally diverse and remote with a very strong clan culture and severely limited government capacity. Civil society - in the sense of voluntarily formed self-governing associations pursuing public purposes – is dominated by the churches of which almost everyone is a member. The CPP represents an engagement with faith-based organisations, working for the first time in PNG with churches and their development arms. The stated purpose of the CPP, which commenced in 2004, is to build the institutional capacity of PNG churches to engage as civil society actors and improve their contribution to service delivery in PNG. It is designed to accommodate the wide variety of organisational structures and capability among PNG’s seven mainstream Christian churches. The seven mainstream churches in the partnership are the Catholic, Anglican, Baptist, Lutheran, Seventh Day Adventist, United and Salvation Army churches.

The program is described as ‘a partnership’ between the seven PNG churches and their counterpart Australian church-based NGOs (ANGOs), as well as with AusAID and the Government of PNG. ANGOs are AusAID’s primary intermediary organisations, responsible (with their church partners) for management and financial administration of the program. The PNG churches are responsible (with the ANGOs) for program development and implementation. The role of AusAID is to provide funding for capacity building and support of health, education and other activities. The Government of PNG is the Executing Authority of the CPP, as stipulated under the Subsidiary Arrangement with the Government of Australia through AusAID. Coordination of the Program is overseen by a Charter Group based in Australia and made up of representatives from the seven ANGOs. There is also a PNG-based Secretariat position filled by a partner church representative. Under the guidance of the Charter Group, the Secretariat provides coordination and liaison functions for the entire program, organising and supporting the partnership.

The focus of the program has been on the capacity building of PNG churches. The initial emphasis of the churches in the CPP was to build a foundational platform of networks and mechanisms that would facilitate more effective delivery of the CPP activities throughout the life of the program. Six

3 Church Partnership Program, Papua New Guinea. DR JESS DART Clear Horizon Consulting MS JO HALL Office of Development Effectiveness Australian Agency for International Development 2011

monthly forums are held in PNG to bring the churches together to discuss relevant issues and to encourage dialogue between the churches. Individual churches implement development activities according to their annual plans responding to locally identified development needs.

Of most significance, the CPP has provided a forum for different church denominations to overcome differences of opinion and to communicate and share knowledge in support of their work in service delivery. This result has been particularly evident in the articulation of the Theology of Development which refers to the shared dialogue around the core religious rationale that motivates and guides all seven churches and their partner ANGOs in their development work. The CPP is also contributing to the quality and coverage of essential services delivered by churches; contributing to income generation and skills development; assisting the churches in their work to promote peace and reconciliation; and has made some contribution to governance at the district and provincial levels. While the program was effective overall, there are a number of outcomes against which progress was not evident or could not be measured through this evaluation.

Working with the churches in PNG is highly relevant for the PNG context. With strong legitimacy among the population, which is more than 95% Christian, churches can contribute to public policy in PNG, enhance government transparency and accountability, support social justice and peace building and develop social capital. In addition the churches in PNG play a crucial role in service delivery – some 50% of health services and 40% of the schools in PNG are run by the churches. In the context of PNG, where the government is relatively fragile with very little capacity, the role of the churches is especially important. The churches themselves have strengths in their legitimacy, widespread presence and ability to shape social capital but can benefit from stronger structures, systems and development practice. Such capacity development is the highly relevant focus of the CPP.

The last and most significant issue from the point of view of this research being a case study for the broader ODE civil society engagement evaluation is the parallel system by which the partnership operates. The history and evolution of the CPP explain why this is the case. It was a new idea for AusAID to work with the churches in PNG. The mode of working through the ANGOs who proposed the idea in the first place made sense. Building on the existing relationships between those ANGOs and the PNG church groups was and is an effective strategy.

There can be a fine line between supporting churches as a mechanism for development and providing funding for religious activities. AusAID needs to be assured that its funds do not place any conditions or obligations on recipients in terms of religious outcomes that would affect their access to services being offered.

It is also important to remember that while church groups have a broad presence in PNG and are well positioned as civil society actors, they are diverse and complex organisations, with variable mandates, capacity and governance capabilities. Continuing to sustain achievements made in fostering dialogue and collaboration between the churches will be important. AusAID’s overall strategy relative to civil society in PNG will be further explored during the country case study as part of the ODE’s evaluation of AusAID’s engagement with civil society.

This case study evaluation presents one modality of how AusAID engages with civil society in the Asia-Pacific region. It represents a unique engagement with faith-based organisations within AusAID’s programs, and an innovative approach utilising existing networks and structures for the achievement of development outcomes. Confounding this assessment is the extreme difficulty of achieving development outcomes in PNG. The CPP was developed to address years of poor performance and outcomes working directly with the Government of PNG and as one mechanism to ensure AusAID support reached remote and marginalised groups.

Case study 3

Costs and Cost-Effectiveness of a Church-Based Intervention to Promote Mammography Screening4

Landis et al. (1999) estimated that 43,300 women in the United States would die from breast cancer in 1999, and that breast cancer would be responsible for 30 percent of new cancer cases and 16 percent of cancer deaths in women. Kattlove et al. (1995) estimated that a reduction of 30 percent in the number of deaths attributed to breast cancer could be achieved through increased use of breast cancer screening at regular intervals, especially mammography.

There are more churches and religious organizations per capita in the United States than in any other country (Sheler 1994), and over 61 percent of women age 50-80 attend church at least once per month (Davis and Smith 1994). The church, an important community resource and a social support network, is a potentially effective vehicle for delivering health promotion projects, especially for older and minority women (Lasater et al. 1997; Ransdell and Rehling 1996; Ransdell 1995; Tuggle 1995; Castro, Elder, Coe, et al. 1995). Whereas interventions that consist only of physician-based strategies can be cost effective for regular users of health care and the insured (Davis, Lewis, Rimer, et al. 1997), a church-based mammography promotion has the potential to reach a wider audience, especially non-white and lower income women who are typically underserved.

The study suggests that a church-based program to promote the use of mammography screening is not only feasible but also cost effective with the use of volunteer labour and resources. Churches are ideal sites for health promotion, as they provide ready access to women between the ages of 50 and 80 from all socioeconomic and ethnic backgrounds. They can, at least in theory, provide the necessary physical resources and a pool of volunteers to serve as peer counsellors and promote

4 Costs and Cost-Effectiveness of a Church-Based Intervention to Promote Mammography Screening Susan E. Stockdale, Emmett Keeler, Naihua Duan, Kathryn Pitkin Derose, and Sarah A. Fox. 2000

mammography screening. To achieve the desired goal of meeting the cancer-screening rates in 2000, the option of a church-based screening promotion program holds great promise.

Road Safety as a Health issueAn issue with road safety is that it assumes that road safety solutions and delivery mechanisms are the same in every country. Additionally, road safety remedial measures often focus on expensive engineering solutions to mitigate what is largely a behavioural issue, probably because most consultants are from an engineering background.

Road Safety is a public health issue and Road Safety is always compared to other health problems (see table below). So why do we not adopt the approach that we would use, when treating any other health issue?

We are dealing with the epidemiology of road death and injury. The goal of epidemiology is to identify subgroups of the population who are at a higher risk of disease than usual and who will benefit the most from disease specific interventions.

Epidemiological information can be used to develop prevention strategies according to: Time (peaks at a particular season); Place (limited to specific geographic areas); or Person (groups at risk)

What are the pathogens in road crashes? The main pathogen is “Kinetic Energy”. If vehicles travel slower there is less energy to transfer in an accident. The vector for kinetic energy is vehicles. Our aim is to reduce the contact or lessen the impact of the pathogen on the population.

The accident is the result of a human system failure. It is not right to blame cars and roads for crashes. They are inanimate objects. The failure is due to human behaviour and human behaviour can be changed.

One of the ways that we do this is by education and training. We could call this the pre-trauma phase. We prepare the population (inoculate them) by:

1. Awareness campaigns2. Types of accidents3. Information on accident consequences4. How to avoid accidents? (seat belts, personal visibility, over speeding, etc)5. How to travel safely (day and night). Rules of the road (Highway Code)6. Using the road safely (safe driving, safe walking)7. First aid training (Dealing with crash injuries, what to do and what not to do). International

Federation of Red Cross and Red Crescent are stakeholders.

Post trauma care looks at what we can do to reduce the consequences of an accident:1. Where to get treatment2. Emergency contact cell numbers. Who to call3. Location of local first aiders4. How to report a crash?5. Help to recover from a crash6. Information on personal liability

Using the church/community networksChurches and the muslim community are the largest social network in African countries. They are also a network with social obligations written in their Holy books.

The churches have a moral duty in this respect because: They have a moral duty to society to obey its laws (including the laws of the road) They have a duty of care to their congregations They have a duty of care to their neighbours (other road users)

In short, if they neglect these, they are neglecting the core of their faith.

Information can be networked relatively easily. It first requires that a commitment is obtained from the denominations to participate.

The programme would then involve:1. The development of a training programme2. Development of training materials3. Training of trainers to network information in their denomination4. Rolling out the programme5. Establishing personal commitment6. Monitoring7. Sustaining the programme8. Feedback

The benefits of the Church and Community networks

Frequency of meetingTo say that getting people together at short notice in Africa is a logistical problem, is an understatement. This is not only due to transportation problems, it also takes people away from their employment (a personal cost) and a consequence of this is that people not unreasonably expect to be paid for attendance. Not everyone has an e-mail address or a house address, so contacts are often made by cell ‘phone which is again, time consuming.

In order to reach large numbers of people it is necessary to hold literally thousands of public meetings. The idea that media (TV, radio, newspapers) offers a reasonable alternative information conduit to community meetings, is true if there are sufficient funds to maintain media outputs over a long period of time. Unfortunately this is not the case. In some countries in Africa, the press even have to be paid to attend an information briefing.

Messages have to be sustained over time (medical equivalent of booster injections) in order to reinforce the message. Because churches gather regularly (not just on Sundays), this high frequency of meetings opens a regular window for “infomercials” (information commercials) dealing with safety issues.

Ease of accessSubject to protocols, agreements and permissions with the various Church Councils, Denominational leaders or local independent churches, access is relatively simple and time effective since meetings occur at regular times and on many occasions during the week.

Ethical imperativeThe basis for participation in social improvements is that it is foundational to the ethics of the Christian and Islamic tradition. This would also extend to duties to the State which also encompass obedience to Civil Laws.

Doing “good” to the membership and neighbours is at the heart of Religious observance. Social improvement programmes are tapping into the existing ethical goodwill.

Social networksThe church networks tend to be linked either through a vertical hierarchy (National church denomination) or through a horizontal network of associated belief groups (“Free churches). These linkages or rather channels, form the conduits through which information can be passed. This can be a very efficient means of information exchange among communities.

High HR levelMost road safety organisations in Africa are too small in terms of Human Resources, to make a measurable impact on road safety. This is proven by the fact the fatality rates and casualty rates continue to rise year on year. The road death epidemic is not being treated effectively. National Road Safety Councils and Road Safety NGOs consisting of, in some cases 6 persons will not be able to make a measurable impact on a population of, for example 10,000,000 persons, unless they draw in more human resources.

Church networks increase the HR capacity of the lead safety agencies. Communities can identify individuals for training and these become the vectors for information.

Individuals in Lead Agencies are often loath to let others be involved in their activities because they view them as a threat to their position. This is a cultural attitude that needs to change and more personal accountability, especially for those in charge (performance related) will begin to address this.

Reinforcement“One off” messages may register for a short period but the impact and benefit decays with time. Information retention improves with repetition and rehearsal. Because the networks described are coherent and meet regularly, reinforcement is not difficult to conduct.

Creating a safety networkThe road safety programmes take time to have a measurable impact since the communities must become sensitised to the issues.

Beyond Road SafetyThese networks, if developed can be used to improve the quality of life for many people in Africa and can be applied to other issues:

Public health Safety in the home Small scale agriculture Preserving foodstuffs Maintaining clean water supplies Avoiding malaria etc……..