Beyond an instrumental approach to religion and development : Challenges for church-based healthcare in Tanzania

Abstract: This dissertation serves as a contribution to the larger ongoing debate on the role of religion in development in an effort to move beyond an instrumental approach. The aim is to study the role of religious agents in development through the prism of contractual partnerships between church organisations and the Tanzanian state in healthcare delivery. Three Christian denominations are included in the study: the Roman Catholic Church in Tanzania (Tanzania Episcopal Conference), the Evangelical Lutheran Church in Tanzania and the Free Pentecostal Church of Tanzania.Three theoretical perspectives are applied to the study of religion and development: (1) an instrumental perspective; (2) a bottom-up perspective and (3) an integral perspective. In order to operationalise the three theoretical perspectives to function adequately for health sector development research, three analytical concepts are included in the framework, namely resource dependency, linking social capital and intangible religious health assets. The methodology is based on an abductive qualitative approach with the use of case studies on the three church organisations (Catholic, Protestant and Pentecostal). Three key methods have been used for collecting data: policy analysis, semi-structured interviews and participant observation. Each organisation is analysed in terms of their Public Private Partnership (PPP) agreements and collaborative models, their relation towards the state, their internal health policies and their motives for delivering health services. Moreover, by including one local hospital per organisation (Turiani, Selian and Mchukwi), it is also possible to integrate the local implementation level into the study. In order to capture the views of public authorities, interviewees from the national Ministry of Health and local Council Health Management Teams have also been included.By entering into PPP health agreements, church organisations have moved to centre stage and gained more influence following the latest political and economic reforms. Their attraction as service providers follows from their existing infrastructure and previous experience and capacity in the health sector. The analysis shows that faith is a key motivator and a central factor in the running of church health services. However, the fact that church organisations are becoming increasingly dependent on the state has implications in terms of their role as a critical voice in the public debate and could potentially threaten their independence as faith-driven civil society actors. Church organisations are also becoming more vulnerable financially, as they are not compensated according to the PPP contracts. The current situation where church organisations are dominating the PPPs in health has implications on both the Tanzanian model of secularism, with its emphasis on Muslim and Christians being treated equally, and the local governments’ strive towards national ownership with their favouring of public healthcare over private alternatives. It is therefore necessary to further study the role of religion beyond an instrumental approach in order to get a deeper understanding of the religious dynamics in the PPPs in health in Tanzania.