Abstract
Faith-based organisations constitute the second largest healthcare providers in Sub-Saharan Africa but their religious values might be in conflict with providing some sexual and reproductive health services. We undertake regression analysis on data detailing client-provider interactions from a facility census in Malawi and examine whether religious ownership of facilities is associated with the degree of adherence to family planning guidelines. We find that faith-based organisations offer fewer services related to the investigation and prevention of sexually transmitted infections (STIs) and the promotion of condom use. The estimates are robust to several sensitivity checks on the impact of client selection. Given the prevalence of faith-based facilities in Sub-Saharan Africa, our results suggest that populations across the region may be at risk from inadequate sexual and reproductive healthcare provision which could exacerbate the incidence of STIs, such as HIV/AIDS, and unplanned pregnancies.
Highlights
Most health systems rely on a variety of differently owned and managed organisations to provide healthcare
In this study we examine how faith-based providers in Malawi compare with government facilities in their provision of sexual and reproductive health services related to the prevention and counselling of sexually transmitted infections (STIs)
The proportion of women attending CHAM family planning services is lower than the estimated 37% of the total catchment population served by CHAM (Christian Health Association of Malawi, 2016)
Summary
Most health systems rely on a variety of differently owned and managed organisations to provide healthcare. Faith-based providers have been shown to be altruistic and pro-poor (Bjorvatn and Svensson, 2016; Reinikka and Svensson, 2010) and have a reputation of offering higher quality of care compared to public providers (Olivier et al, 2015). Their religious beliefs may be in conflict with the health goals of international organisations and national governments which follow secular principles. This is of particular concern in the context of ensuring that individuals have access to family planning methods and HIV prevention (Tomkins et al, 2015). Smith and Kaybryn (2013) provide evidence that faith-based providers, do not always conform to public health policies related to Sexually Transmitted Infection (STI) prevention and have resisted condom promotion, whilst O’Brien (2017) argues they have led to a shortfall in preventing HIV/AIDS because of their focus on abstinence over condom use
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