Access to Medicines in Church Health Services in Africa. A Cross-country Analysis of Compliance with the Ecumenical Pharmaceutical Network Guidelines on Effective and Efficient Pharmaceutical Services
(2010; 63 pages)


This report analyses compliance with the EPN guidelines for access to medicines in the church-related health services (CHSs) of Ethiopia, Ghana, Malawi, Uganda and Zambia, and includes data from Nigeria, Tanzania and Togo. The report covers results from 363 health facilities, representing over 20 000 beds, over 4 million outpatients and budgets totalling more than 40 million US dollars. More than 50 focus groups were held with church leaders and more than 50 guided self-assessment meetings were held with hospital staff. Five national feedback meetings were also held.

The self-assessment survey results for the 127 hospitals, 178 clinics and 58 health posts describe the situation in a significant group of CHSs, from which it is reasonable to extrapolate results for CHSs across Africa. Even when, for example, most of the responses from Ghana were from the wealthier Southern areas, the poorer North of the country can be assumed to be similar to the CHSs in Ethiopia or Malawi, where conditions are similar.

It is assumed that responses came from the more active and involved facilities, and that therefore the results could be weighted towards scores higher than the true average. With over 21% of the hospitals analysed coming from Uganda, the results could have a further bias towards higher rather than lower scores which would reflect the relatively advanced development of health services in Uganda.

It is estimated that CHSs in sub-Saharan Africa provide 40% of the available health care, rising to as much as 90% in many rural areas. The significance of the CHSs is recognized by parts of the WHO and the World Bank, both of which make special efforts to work with the sector. However, these same organizations and a large number of other health actors in resource-poor environments do not match the size of the service provision with their commitment to the church health sector.

Unfortunately, no comparison can be made with government-run health institutions as no comparable survey has been carried out. However this study has resulted in:

  • five country baseline studies: Ethiopia, Ghana, Malawi, Uganda and Zambia (chronologically: Malawi, Ethiopia, Ghana, Zambia and Uganda);
  • partial country baselines for Nigeria, Tanzania and Togo;
  • a situation analysis for church-related health services across Africa.

For the first time, it has been possible to involve Christian health associations (CHAs), drug supply organizations (DSOs), church leaders and CHS staff in the process of identifying priorities for interventions as well as possible approaches to address these priority issues. It is now also possible to describe some aspects of the Christian health services in Africa, such as to:

  • assess levels of access to essential medicines through CHSs;
  • identify the most prevalent problems in CHSs in relation to access to essential medicines;
  • measure change in the level of access to essential medicines in CHSs and whether that change relates to changes that are within the control of CHSs or not.
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