Päivänsalo, Ville (2014). 'Faith Organizations for Health Capabilities in Fragile Societies' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.

One of the key movements in the promotion of the emerging modern medicine across the global South was Christian medical mission. The idea of Protestant healing ministry was influentially discussed and updated for example in the Tübingen Consultation (1964) and the Makumira Consultation (1967). Towards our times, most of the low-income and middle-income countries have managed to improve their public health services a lot. However, as for example Dominic Haazen (2012) has argued in the case of Tanzania and Jean Drèze and Amartya Sen in the case of India (2013), translating economic development into well-functioning health systems with universal coverage has still appeared as a huge challenge. And unfortunately, in a number of countries, factors ranging from poverty and violence to the instability of public finances still form acute risks to the positive trends in health development. Hence also the need for multidimensional analyzes of health care and health promotion in fragile societies has remained highly topical.

In Tanzania, the government continues to cooperate with Christian faith-organizations in health service provision—churches run more than a third of the health facilities in the country. From the perspective of e.g. the Evangelical Lutheran Church in Tanzania (2010), the church's health programs have often been regarded as the 'healing arm of the church.' In India, to compare with, Christian health facilities have been basically on their own in relation to the government and, during the past couple of decades, usually also to Western faith organizations. Yet there are hundreds of Protestant hospitals and much more Catholic ones in this vast country, and a whole range of humanitarian and development organizations inspired by Christian faith. The most rapidly growing forms of Christianity in these countries, however, are charismatic in character, nourishing forms of healing ministries that can be quite apart from modern medicine. This development intensifies the need for such faith-related approaches to health promotion that accord with scientific medical reasoning.

In the current paper, I will explore how the capabilities approach—especially as elaborated by Sen—can advance our understanding of the roles of faith organizations in the promotion of health in fragile societies. I will refer to certain Lutheran agencies (churches as well as humanitarian and development agencies) in Tanzania and India as examples in my analysis. The emerging analysis will be based on texts produced by Lutheran agencies (particularly ELCT, UELCI, LFW/DWS, LWSIT, and TCRS) and supported, when needed for clarification, by the relevant literature about the contexts in question (e.g. Jennings 2008; Sheikh and George 2010; Haazen 2012; Taneja 2013), human capabilities and health (e.g. Sen 2009; Ruger 2010; Venkatapuram 2011; Wolff 2012; Drèze and Sen 2013), and also about religion in development (e.g. Deneulin with Bano 2009; Rees 2011). In addition, I will take into account the relevant comparisons in terms of the Human Development Index (HDI) between India, Tanzania, and some other countries with quite different shortcomings of health justice when looked at from the perspective of human capabilities. Although the discussion of Lutheran perspectives on the advocacy of health-related social rights has been alive regarding the countries in question (the HIV/AIDS pandemic as one of its recent focus areas), I will move beyond individual standpoints towards an analysis of a dialogical and cooperative promotion of health capabilities under the conditions of fragile societies.

I will argue, first, that despite the observed improvements in the public health services in Tanzania and India, both non-confessional and faith-based voluntary agencies are needed to complement the public sector provision as far as we can see. Their share of the overall health care provision, in the case of continuing nation-wide progress, may quite adequately decrease. In a broader comparison, however, the current economic crisis has compelled even most of the high-income countries to impose public sector austerity programs and also to cut development funding contribution. Hence, our time is not really a time to speculate about perfectly just health systems either in the South or in the North. What is needed instead is further understanding of the models in which governments, as the primary responsible agents as a matter of justice, would sustainably improve the essential public health but various civil society agencies would assume significant imperfect duties as well (cf. O'Neill 2000; Sen 2009).

Second, the observed developments—together with the future scenario of long-term austerity and the normative assumption about the governments as the primary responsible agents of health justice—suggest that faith-inspired health work could be mainly focused on capability-building rather than actual health care provision. This development, which has partly occurred already, opens up a highly interesting field to be explored in view of the capabilities approach to fragile human development. The Lutheran documents to be looked at in this paper provide one type of a solid research material; corresponding ventures in the contexts of other faiths would be most welcome as well.

Both Amartya Sen (2006) and Martha Nussbaum (2007; 2012) have already paved way for the discussion of many aspects of religion and justice, but not really in the field of health capabilities. It belongs, however, to the core of the capabilities approach that it provides conceptual tools for analyzing various ways in which both material and cultural resources could be transformed into health capabilities and subsequently into human freedoms, functionings, and flourishing. It is a high time to make use of these tools extensively also in the contexts faith-based health work. As neither religions nor the need for voluntary promotion of health capabilities is going to disappear into societal margins, we are also bound to utilize the best available conceptual instruments to discuss some of the complex intersections between these broad phenomena. And it has been among the evident strengths of especially Sen's view to address complex justice issues both flexibly and with a genuine concern for human development.