Faith-based organizations in pharmaceutical systems: an assessment of their role and identification of opportunities for system strengthening
Embargo Date
2027-08-22
OA Version
Citation
Abstract
BACKGROUND: Access to pharmaceuticals remains a significant global challenge, especially in low- and middle-income countries (LMICs), where health systems often struggle due to limited government capacity. While governments are responsible for ensuring access to essential pharmaceutical products and services, private sector actors, including faith-based organizations (FBOs), play a critical role. Despite their long-standing presence, the roles of FBOs in pharmaceutical systems remain under-documented. This study aimed to address this gap by assessing the contributions of FBOs to pharmaceutical systems and identifying strategies to optimize their functioning.
METHODS: Using the pharmaceutical systems strengthening (PSS) framework as a conceptual basis, we conducted a scoping review and a convergent, parallel mixed-methods study. The scoping review was guided by the Arksey and O’Malley approach to explore how FBO roles in the pharmaceutical systems of LMICs are described in the literature. The mixed-methods study used the Ecumenical Pharmaceutical Network (EPN) as a sampling frame to collect empirical data on FBO roles. Surveys were deployed to 5 Drug Supply Organizations (DSOs), 4 Christian Health Associations (CHAs), and 40 faith-based facilities across 5 African countries. In-depth interviews were conducted with public, private, and faith-based stakeholders in Kenya. Finally, an action SWOT analysis was applied to the findings, and we proposed actionable strategies for optimizing the pharmaceutical functioning of FBOs.
RESULTS: The scoping review included 30 papers, all of which addressed Christian FBOs, primarily in African pharmaceutical systems. The survey had a response rate of 87%. Interviews were conducted with pharmacists, medical doctors, program directors, and religious leaders operating in Kenya and other countries in Sub-Saharan Africa.
FBOs contributed to all components of the pharmaceutical system, with the most prominent involvement in pharmaceutical products and related services. All FBOs engaged in selection and procurement in alignment with best practices. National-level FBOs (DSOs and CHAs) also contributed to pharmaceutical policies and governance, human resources, financing, regulatory systems, information, innovation, research, and development. At the service delivery level, most faith-based facilities reported linkage to national health information systems. However, persistent gaps in service delivery, including pharmaceutical staff shortages and suboptimal policy coverage, were apparent. Country-level differences highlighted how context shapes FBO operations.
Qualitative findings emphasized the influence of relational dynamics and sectoral priorities on FBO engagement. Religious ethics inspired trust, positioning FBOs as valued partners. Furthermore, system interactions were apparent; for instance, limited financing hindered the attraction and retention of qualified personnel. The SWOT analysis identified well-established DSOs and FBO structures that facilitate pharmaceutical supply, coordination, and leadership as strengths. Weaknesses are apparent in lack of financing and limited impact measurement; threats include donor dependency and unreliable insurance reimbursement. Opportunities lie in pharmaceutical workforce development, and expansion of quality and safety surveillance.
CONCLUSION: This study offers a nuanced assessment of FBO contributions to the pharmaceutical system and presents three key implications for pharmaceutical systems in Anglophone Africa: the urgent need for sustainable financing, the importance of partnerships to ensure access to quality pharmaceuticals, particularly in resource-constrained settings, and the necessity of strengthening pharmaceutical service delivery, where patients first engage with the healthcare system.
Description
2025