Measuring What Matters in Community Transformation

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In management, there is a saying, "you get what you inspect, not what you expect". However, how do we know exactly what to inspect in the transformational development process? for example, if we looked only at the instruments showing the vial signs of a patient in a coma but kept alive on life support systems, the instruments would show that vital signs are within the ideal range. However , the doctor treating this patient would be most concerned about when the patient's CNS would take over responsibility for all the vital organs to function normally. We understand this well in Medical science, but somehow forget all about it when it comes to community development. Empowerment takes a back seat, and other indicators take on prominence, despite the fact that we know that things like vaccination levels, disease incidence etcetera can be made to "look impressive" by directing inputs in a particular way. We are often content to become service providers for health care and management, and take on the responsibility for 'ensuring that the community is healthy'. We are even happy with the community being a passive recipient of our services, because the outcome is good - immunization levels are up, people are healthy. But what happens when the program is over? Do things just revert back to where they were before we started? does anyone go back to check? A good friend of mine , Dr. Stanley Foster (who spent over 50 years in Public Health in CDC and Emory University) is a strong advocate for evaluation of intensive massive health care projects two years after the projects are over!!!
One can say without a doubt that if the community was not engaged from the beginning in the planning and empowered as a part of the project design to take responsibility for their health ; the outcome would be pretty embarrassing. This session focusses on identifying what matters in the development process (Empowerment, progress towards the MDGs, etcetera) & finding ways to measure them.

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THE CHURCH AND GLOBAL ACCESS TO HEALTH CARE
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The World Health Organization (WHO) tells us there is a need for another 7.2 million health workers in the developing world and this shortage is expected to grow to 12.9 million by 2035 (World Health Organization, 2013). The WHO also warns that if this crisis is not addressed now to slow or stop the growth of this shortage, it will have serious implications for the health of billions of people across all regions of the developing world. Global Health Inequities The World Health Organization (WHO) also tells is that 5.9 million children under age five died in 2016, about 16,000 every day. The risk of a child dying before the age of five is still highest in the Sub-Saharan Africa at 81 per 1000 live births, which is an incredible seven times higher than in developed nations. Compare that with the WHO European Region where that number is 11 per 1000 live births. The under-five mortality in low-income countries remains unacceptably high averaging 76 deaths per 1000 live births. This is about 11 times the average in developed countries, which is 7 deaths per 1000 live births (World Health Organization, 2017) (United Nations inter-agency group for child mortality estimates, 2015). Maternal mortality is also a enormous problem. 830 young women loose their lives each day ( about 330,000 annually) due to complications and 99% of those deaths are in developing countries; a direct result of lack of functional functional healthcare systems with surgical capabilities (World Health Organization, 2018).  A True Social Justice Issue One way to spot a true social justice issue is look where the Christians are working on behalf of the poor. Out of all the players in global health care, Christians have been by far the most actively  engaged in this problem. However, I fear this high level of engagement is now changing. There have been hundreds if not thousands of mission hospitals founded by many Christian denominations, these mission hospitals are often the only access to lifesaving healthcare for vulnerable populations. Motivated by faith and passion to share the compassion, love and mercy of Christ nearly every Christian denomination created hospitals and health programs to care for the poor globally. The Role of the Church in Global Health Care Christian Mission hospitals and health programs account for about 50% of all healthcare delivered in Sub-Saharan Africa (Olivier, et al., 2015). That figure is probably closer to 70% of the truly functional healthcare services delivered.  Sadly however, many of these Christian facilities are closing, those that remain are fighting for survival. This is not isolated to African countries, a recent report  tells us there have been approximately 200 Christian hospital closings in India alone in the last two decades. These facilities are often in remote rural locations making it difficult to attract and keep national health professionals and the only access to lifesaving healthcare for vulnerable populations. Christian missionary physicians and nurses started these facilities and have staffed them since their inception, however there are no longer enough medical missionaries to staff them. Our best estimates are that there are only about 1300 missionary healthcare providers  still serving full-time around the world. This is not nearly enough to cover even a small percentage of the need. This has left many poor communities without any access to functional healthcare, or the Christian witness these facilities once provided. As a global Church we cannot disengage from health care,  it is part of our identity as a faith community. It is no accident that out of the nearly 4,000 verses in the 4 gospels, 727 of them have to do with healing. The Churches role in health care for the poor globally is, and should continue to be, our tangible expression of Christ to the nations that we cannot abandon. Alkire, B., Raykar, N., Shrime , M., Weiser, T., Rose , J., Nutt, C., . . . Farmer, P. (2015, June). Global access to surgical care: a modelling study. The Lancet, 3, 316-323. United Nations inter-agency group for child mortality estimates. (2015, September). Inter-agency Group for Child Mortality Estimates. New York: UNICEF. Retrieved from https://www.unicef.org/publications/files/Child_Mortality_Report_2015_Web_9_Sept_15.pdf  World Health Organization. (2013, November 11). WHO Media Center . Retrieved from World Health Organization : http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/ World Health Organization. (2018, February). Fact Sheet on Maternal Mortality. Retrieved from World Health Organization Newsroom Fact Sheets: http://www.who.int/news-room/fact-sheets/detail/maternal-mortality