International Ministries

Community Ownership: The Health Center is our Baby

January 15, 2014 Journal
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This week I was talking to a Marist Brother about Catholic conceptions of poverty.  He observed that Catholic teaching about poverty puts the emphasis on the nature and quality of relationship with God, creation and other people rather than on the abundance or lack of material possessions.  Poverty is measured in terms of knowledge of, obedience to and dependence on God.  To the degree that material wealth contributes to (or detracts from) this knowledge, obedience and dependence, a person or a society can be considered rich or poor.  Working in a context where people typically have limited material and financial resources and where many Congolese have grown to accept as destiny the identities of "poor" and "helpless", I found this a liberating, refreshing reminder. 

Part of my ministry has been to help materially poor communities to rediscover the power to change their circumstances with the resources that God have given them.  During the last year this took a new turn as I became the coordinator of a program that currently encourages local communities in 17 health zones to assume part-ownership of their local health centers and to partner with the health workers that are supported (or more often not) by the state.  Both Catholic and Protestant churches across the country have understood the need for this since before the post-colonial health service was organized nearly 4 decades ago.  And often we have led the way.

In theory, community health committee (CODESA) members are respected community leaders with responsibilities for co-managing their area health center. IMA World Health and the ASSP (Access to Primary Health Care) Project are encouraging these representatives to explain to their neighbors the need for and the benefits of community support for the health center and partnership with health center staff. We hope that these men and women will become key agents explaining the Community Health Endowment initiative and recruiting community groups to provide modest, but crucial, supplementary support that lowers out-of-pocket costs for users and ensures availability of primary health care when it is needed.

This past week ASSP Partner CARITAS started a series of orientation workshops in six health zones. (Another series of 9 workshops was conducted in Kasai Occidental in early December.)  I observed as colleague Pastor Ruben Ngalubenge led participants through exercises on the essentials of community contributions to the health center, facilitating or moderating community meetings, and urging people to make a choice, even if it is to pass on participating.   Unlike many humanitarian aid programs, the Community Health Endowment program offers no material goodies, but asks materially poor communities to be the main agents of improving their community.  In Alunguli and Kindu, I kept expecting people to cynically reject the idea.  But I was constantly surprised.  Community leaders seem to say, "If it means reliable, quality basic health care and if health workers will use our contributions wisely, we are ready to join in."

In the three workshops that I observed, nearly 100 CODESA members participated.  They coined the slogan, "The health center is our baby", and one group even suggested a campaign jingle to promote community ownership.  Over the next year they will conduct community meetings to present the idea and invite community groups to join up.  If community groups share the same enthusiasm, local health care workers may find themselves better supported and appreciated than anyone else on the government payroll.  More importantly, good basic health care will be available to even the poorest residents of health center areas.

(Note: Our partner in Maniema province is CARITAS, ably led by Dr. Cyprien Masaka.  CARITAS is a coalition of local Catholic religious and laypeople dedicated to helping poor and marginalized people meet basic needs and gain a measure of dignity and respect.  They want to reflect the love of God and the transforming power of Christ in local communities.  Pray for God's guidance, encouragement, and protection for them as they minister in Jesus' name.)