The Changing Landscape of Mission Hospitals

The Christian mission hospital has been central in the health mission movement. They have provided healthcare to the underserved and the unreached and trained cadres of health workers.  To this day mission hospitals remain an important part of the delivery of health care to populations in many low- and middle-income countries, complementing national health care systems.

As acknowledged in the Lancet series on faith-based healthcare in 2015, many of these facilities have focussed on providing services to hard-to-reach populations, to the poor and to fragile or weakened health systems. The authors also noted the role of mobilization and support of volunteers, and innovative fee structures and governance approaches.

However, the environment in which these hospitals exist has changed dramatically over the last few decades including the following:

  • Increasing government regulations and enforcement or expectations that they will integrate with or work under government control
  • An expectation that hospitals should offer specialty and subspecialty services supported by the necessary specialist staff
  • From less reliance on foreign missionaries, who in some places have been unable to obtain visas, to increased reliance on locally trained health workers for hospital staff and leadership
  • Increased options for faith-inspired healthcare workers to work in and to improve government hospitals and/or corporate hospitals
  • Changing financial models from dependence on foreign donations towards dependence on patient fees, government funds or even business models.

These faith-based healthcare institutions face additional challenges such as unpredictable financing, religious opposition, variable governance and priorities that may differ from national health systems.   Many mission hospitals have had difficulty in adapting to this changing environment and many have shut down.  For example, in India there were around 700 protestant mission hospitals at independence in 1947 and this has fallen to around 200 (personal correspondence, Vinod Shah).

With this background, we seek submissions that will fill this important gap in the literature, suggest better health outcomes and improve our understanding of mission hospitals by addressing the following:

  • The transition of past, current and future roles, and the uniqueness of these roles.
  • The relevance of mission hospitals to meet the SDGs, and their importance for world mission objectives.
  • Redefining the purposes and practises of mission hospital facilitates; adaptation to include community-based programs, education, public health initiatives or sub-specialising.
  • What can be done to promote sustainability of medical mission hospitals, the promotion of research evidence-based quality, chaplaincy, and the inclusiveness of provision of services to the poor.
  • The role of foreign entities in supporting existing mission hospitals.

Deadline for submissions for this theme issue 31 March 2020.

Reference:

Faith-based health-care. Lancet series. Available from: https://www.thelancet.com/series/faith-based-health-care

Olivier J, Tsimpo C, Gemignani R, Shojo M, Coulombe M, Dimmock F, et al. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. Lancet 386(10005) 31 Oct 2015. https://doi.org/10.1016/S0140-6736(15)60251-3 

Green A, Shaw J, Dimmock F, Conn C.  A shared mission? Changing relationships between government and church health services in Africa. Int J Health Plann Manage. 2002; 17: 333–353. https://doi.org/10.1002/hpm.685

Palmer JJ, Gilbert A, Choy M, Blanchet K. Circumventing 'free care' and 'shouting louder': using a health systems approach to study eye health system sustainability in government and mission facilities of north-west Tanzania. Health Res Policy Syst. 2016;14(1):68. Published 2016 Sep 9. https://doi.org/10.1186/s12961-016-0137-9