Faith-based organisational management: strengthening church-led healthcare provision in Malawi and Zambia.
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Collaboration between government, faith-based organisations (FBOs) and local communities for healthcare management and delivery in southern Africa or continentally, are seldom the focus of empirical study. The core work of churches is pastoral care. Literature searches reflect that pastoral care characterised by congregational governance lacked healthcare management strategies and stakeholder inclusivity in church-led management of local healthcare. With this point of departure, the current cross-national study of four mission hospitals explored challenges and opportunities for church-led hospitals to perform healthcare management functions in collaboration with government and communities. Driven by the transformative worldview, this qualitative study used multi-grounded theory and case study strategies in tandem with a design of meta-conceptual framework in stakeholder-congregational style. Two Malawian mission hospitals in Ekwendeni and Embangweni led by the Church of Central Africa Presbyterian (CCAP), and two Zambian mission hospitals in Mbereshi and Mwandi led by the United Church of Zambia (UCZ), provided units of analysis for the intra-country and international study. Combined study participants included 38 interview informants and 144 focus group participants across 13 focus groups comprising a range of diverse stakeholders. Data sets were analysed through a combination of content, thematic and matrix approaches. Findings revealed the need for secular management training to be integrated with pastoral care approaches; that hospital workers perceive themselves minimised from inclusivity in management decision-making, and that members of civil society believe themselves marginalised from participation in operation and management of healthcare delivery. Recommendations for systems strengthening are made such as reformation of formal mission hospital management and administration structures to allow wide stakeholder participation. Further, local people should be empowered with capacity and skills to participate in preventive and curative interventions to make meaning from ‘community-based’ healthcare. The study contributes a conceptual model towards this end. Re-visiting collaborative arrangements between church, mission partners and government with stakeholder inclusivity and community voices in mind would help reconstruct the meaning of faith-based community participatory healthcare in this era of a globally networked society, and for southern Africa countries in particular.