Recently listening to Peter Saunders share about the Mission Hospital (MH) database project in a MedSend conference (see video here), and David Stevens sharing in a webinar on ‘Strengthening Mission Hospitals’ has challenged further exploration of the question, how do we strengthen church and mission hospitals?

In this short post, I reflect on some lessons from nations that seem to have done well, in supporting their church-run and other mission institutions. These reflections are based on stories I have heard from some of the founders of national hospital associations and trying to draw some principles from these stories.

This is in no way comprehensive and complete but is written in the hope that some of the issues raised might stimulate more questions and ongoing reflections within ICMDA and its member organisations. I have not given many references as we do not yet have data to prove all that is written. So, these might look anecdotal and nebulous, but I hope will be the start of asking further questions on these assumptions or observations.

Many southern continent nations have had large numbers of MHs started by international mission agencies (IMAs). Most of them started in late 19th century or early 20th century. This was during the large cross-cultural missionary movement of those decades.

Most nations currently are facing or have already faced reduction in the numbers of such institutions, expect for a few well-run ones. These exceptions do well due to specific teams or support systems. But in the midst of such a global decline, there are signs that in some regions or nations, there is still life and energy. What are some of the reasons for such ongoing life and energy, what are some of those systems, processes and directions that make these locations different?

I want to look at six themes or directions that might have contributed to such a difference.

1. National Hospital Associations

Nations that have seem to do well are those who have been able to build and strengthen National Hospital Associations which are owned and led by national leaders.

We see such examples in South Asia and some African nations. In these nations, IMAs recognised the need of moving from focusing on running their institutions to playing a facilitatory role. Some IMAs even gave up their institutions to national organisations for a greater purpose of building and strengthening national hospital associations. There are stories of missionaries who gave up their positions and roles and travelled all over the nation to encourage mission institutions to come together and support the formation of National Hospital Associations and support the national ownership and running of such associations.

RW, a well settled CT surgeon in the most prestigious institution in the nation, gave up his position, travelled all over the nation where he was a missionary, to understand the context that was emerging in MHs. He met with the church leadership of that nation and challenged them to form a health care association that would run and manage the potentially closing MHs.

2. Christian Medical and Dental Associations

Many of these nations did not have a strong Christian Medical or Dental fellowship or organisation, at the time when hospital associations were formed. Where there were strong CMDAs or CMFs or where such groups were established alongside, and where the CMDAs or CMFs and hospital associations have held hands to support each other and grow together the MHs have done well. This was very evident again in South Asia and some other African nations.

FG, a professor of surgery and a missionary, took five years leave and travelled across the nation he had come to adopt as his own, challenging national young doctors to form a new CMDA for the nation.

3. Handing over control to health professionals

In many contexts and locations, the institutionalised church that did not have the know-how of running complex medical institutions, ended up managing these institutions not too well. But where the church and mission agencies gave control to trained healthcare and management professionals to run MHs, institutions seem to have done better. These people were those who can strategise and plan to take institutions forward.

4. Leadership development

Where proactive leadership development was a focus, national hospital associations have done well. Where senior and second line leadership has been built intentionally, there is still a cadre of leaders who provide leadership from the front. In some nations IMAs focused on this as their strategy of transition. Some nations like India were privileged to have IMAs who built Christian Medical colleges which played a major role in leadership development. In other nations national CMDAs or CMFs have proactively focused on leadership development, and built a cadre of trained professionals who are willing to take the leadership of institutions.

HS, a missionary family practitioner, in a MH, spent one year, traveling to all the medical schools and major towns and cities, meeting with young consultants and faculty, challenging them to move into MHs and take responsibility for these institutions. He gave up his position and role to focus on the bigger picture of the nation.  

5. Ongoing mentoring

Supporting and motivating these young leaders and journeying with them is key if these leaders must take institutions forward. Where ongoing mentoring support is provided to these leaders who have taken up responsibility and such systems and process have been set up, MHs seem to have done well.

6. Good governance

Studies have shown that in addition to HR, the other factors that influence MH sustainability are Governance and Hospital Management systems, (finance, material, human resources, quality statutory etc). David Stevens has addressed this well in his webinar. Those institutions that are doing well are those where such issues have been proactively addressed.  

The way forward

There will be many other issues like professional training and financial support. But one thing that stands out in all these contexts that are well doing are that there was a proactive and engaged leadership. COVID-19 had taught us that in locations where such leadership exists, institutions engage effectively.

How can we understand some of these issues better? What other factors are important? How can we start supporting MHs in nations where ICMDA has its presence?

Responses and reflections from the ICMDA family are invited.

Santhosh Mathew is ICMDA Head of Training and South Asia Regional Secretary

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