Health systems strengthening through the faith-based sector: Critical analysis of facilitators and inhibitors of nationalization of mission hospitals in India

Abstract

Introduction: The extensive network of Christian mission hospitals in India faced an abrupt loss of financing and supply of medical missionaries during and after independence in 1947. Many of the remaining went on to become indigenously owned Christian hospitals and prestigious medical colleges that maintained the heart for the poor and for spiritual care that was inspired by their founders. The aim of this critical analysis is to explore the literature to understand what helped these hospitals survive when others failed and lessons that can be learned to help direct future investment and programs for health systems strengthening. Methods: A literature review was conducted utilizing PubMed and Google Scholar and combinations of keywords (mission, hospital, India, independence, indigenization, sustainability, history, health system). The initial list of 785 articles was filtered down to 28 that specifically address the research questions. Excerpts from these articles were annotated, coded, and evaluated for core themes. Results: The following core themes arose as factors that contributed to their success: 1) shared mission, vision, and core values, 2) early emphasis on medical education, especially for women, 3) local champions, patrons, and governance, 4) strong community linkages, 5) strategic collaborations, and 6) healthy systems and infrastructure. Recommendations: Most international investment in health systems strengthening has focused on short- and medium-term health outcome goals. While these have certainly saved the lives of millions, we must also consider what will be required to foster healthy healthcare systems. Long-term investment in building committed healthcare leaders and healthy institutions is challenging, but necessary, to meet long-term health goals. Faith-based hospitals are key allies in this endeavor.