"Hidden Catholics","faith-blind" donors and "FBO empires" : a mixed-methods study on donor engagement of faith-based organisations in the Cameroonian health systema mixed-methods study on donor engagement of faith-based organisations in the Cameroonian he

Abstract: Over the past decade, donors have engaged Christian faith-based organisations (FBOs) in health system reforms and health programmes in numerous sub-Saharan African countries. They enjoy a good reputation for the assumed quality of care they can provide, their ability to reach the poor, and their market share in health systems. However, little knowledge is available concerning the process and implications of donor engagement of FBOs. This research uses a mixed-method case study approach to describe and analyse the reasons, processes, and implications of donor engagement of FBOs in the health sector in Cameroon. Three examples of different forms of donor engagement of FBOs in health programmes in Cameroon are used to offer further knowledge on the subject. The study makes three significant findings: Firstly, it identifies a very diverse range of FBOs that participate in the health sector: faith-based networks, faith-based health training schools, faith-based service providers that are integrated into the health system, and faith-based 'Centres of Excellence', which operate with little interaction with the state. This diversity suggests that a re-examination of the 'FBO' buzzword is necessary. Secondly, the study shows that FBO engagement by donors has often been done with many assumptions about their faith attributes, their role in the health system, their relationship with the state, and their capabilities. Donor's flawed assumptions have had negative ramifications for the equity and quality of health care provision in Cameroon. Thirdly, I argue, although many donors have embraced FBOs, the evidence suggests that controversies regarding the relationship between religion and gender, and the relationship between FBOs and the state still matter. This work provides a non-instrumental perspective, which includes the views of FBOs of their various engagements; it shows that the role of the donors in shaping these organisations and their relationships is core to furthering our knowledge about FBOs.