Religious Health Assets Mapping
The African or International Religious Health Assets Programme (ARHAP/IRHAP) is a collaborative working group that includes partners from Rollins School of Public Health and Interfaith Health Program, Emory, Wake Forest as well as University of Capetown, University of KwaZulu Natal and Wits in South Africa, Difaem (German Institute for Medical Mission) and the Vesper Society in the USA. ARHAP, in conjunction with the World Health Organization (WHO), have undertaken documentation of religious and health assets via a process called PIRHANA (Participatory Inquiry into Religious Health Assets, Networks and Agency) and a Practitioner’s Workbook has been developed to guide future researchers in use of this model. (1)
Under the leadership of Rev. Dr. Gary Gunderson (member of the IRHAP working group; VP of the Faith Health Division, Wake Forest Baptist Health) FaithHealthNC participants are applying the tools and mapping process refined in South Africa and Memphis for use across North Carolina.
Using the PIRHANA model, religious assets health mapping has been conducted by ARHAP in South Africa, Zambia, Lesotho, other countries (2), as well as in Memphis, TN, where over 16 workshops were conducted from 2007-2012. The PIRHANA approach honors, articulates and “calls out” specific religious health assets of both a tangible nature (church buildings, health ministries, leaders who hold both faith & health leadership roles) and intangible nature (blessings, relational ties to other programs and organizations). ARHAP is interested in what contributes to health and healing understood in the more holistic African context, involving comprehensive well-being of the community, body, mind and spirit.
PIRHANA recognizes that a significant asset of religion is the networks and relationships that it fosters (assets sometimes termed as “social capital”). Additionally, the inquiry is based upon the framework that people are “actors” in the field of both religion and health and that their faith impacts them as they engage in both health-seeking and health-providing behavior (agency). The approach is grounded upon appreciative inquiry, so seeks to be empowering-not extractive. Local members of the communities that are mapped drive the inquiry and have ownership of the work and findings (exemplified in PIRHANA as “handing over the stick”).
Strengths, Not Weaknesses
By focusing on the strengths of our worshipping communities, we enhance our communities’ collective ability to prevent illness, help individuals self-manage chronic conditions and enhance overall health on a community level. PIRHANA builds on the foundation of what we actually have, rather than focusing on things that we may not have. The assets of faith groups are distinctive in that they may appear to be intangible, yet they produce highly tangible relationships, connections, values, trusted stories and powerful rituals that make it possible for the whole strength of our communities to rise to the challenges and threats we may face (3). Leaders at all levels of our faith groups can be engaged as allies in healthcare and public health initiatives to build healthy, responsive communities. These processes capture more creative, yet realistic ideas about leveraging religious health assets from both healthcare and faith community partners.
PIRHANA practitioners aim to document the assets of faith and health communities, as well as locate them in neighborhood structures and relationships. Additionally, PIRHANA practitioners focus on delineating exactly how these assets work and explore how they can be aligned to broader policy.
The PIRHANA process is conducted by following two levels of inquiry, with different constituents within a given catchment area:
- Community seekers (grassroots leaders)
- Community providers (neighborhood based)
Specifically, the inquiries focus on these key questions:
- What is the context for religion and health in this community?
- What are the key factors in this context that work for and against health and well-being?
- What are the key public and private entities/organizations that influence health and well-being in your area? What are their relative contributions to health?
- What are the most important ways that religion and religious entities contribute to health in your area and specifically to a targeted health condition’s treatment, care and prevention? What are their relative contributions?
- What are the “best”/ “most effective” religious entities/programs? Of which are you “most proud”? What are their characteristics and locations?
- What can you do to help religious organizations and entities in your area make a greater contribution to health? What will you do as a result of this workshop?
Key components of the inquiry include community mapping, timeline creation and development, spider-gram exercise, the health/sickness index, facility/health ranking, religion/health index and religion/health ranking. These data are captured from all three levels of inquiry and a compiled report is developed and shared with all participants.
Findings From PIRHANA
Global findings from PIRHANA indicate that:
- the process itself is empowering
- health crises are allowing “openings” for more intentional partnerships and intersects between faith and health groups
- “assets” like love, hope, caring, education and moral instruction have strong roles to play in combating health problems
Additionally, the work reveals that community markets or non-traditional sites can be designated for health and education efforts and that religiously owned hospitals and clinics garner greater trust than government-based organizations and providers. Specific findings are also promising, in terms of clinically-based outcomes. For example, the Masangane project “Let us Embrace” is a community faith- based group that has been able to deliver anti-retroviral therapy (ART) to AIDS patients approximately 3 months faster than their governmental counterparts (4). In Memphis, early mapping is believed to have contributed to the health utilization improvements seen with the Congregational Health Network (CHN) partnership with Methodist Le Bonheur Healthcare (5).
- Steve DeGruchy, Sinatra Matimelo, Debbie Jones, Sepetla Molapo and Paul Germond, PIRANHA: Participatory Inquiry into Religious Health Assets, Networks and Agency, Practitioner’s Workbook (University of KwaZulu-Natal: The African Religious Health Assets Programme, 2005).
- Jill Oliver, Lauren Graham, Barbara Schmid. ARHAP Literature Review: Sub-Saharan Africa (Capetown South Africa, 2006).
- Gary R. Gunderson. Addendum to Advisory Role of Worshipping Communities Amid Pandemic. Unpublished manuscript (Memphis: Methodist LeBonheur Healthcare, 2005).
- Liz Thomas, Barbara Schmid, Malibongwe Gwele, Rosemond Ngubo, James R. Cochrane, “Let Us Embrace”: The Role and Significance of an Integrated Faith-Based Initiative for HIV and AIDS. Africa Religious Health Assets Programme (ARHAP) Research Report: Masangane Case Study. Eastern Cape, South Africa, 2006.
- Cutts, Teresa. “The Memphis Congregational Health Network Model: Grounding ARHAP Theory ” In When Religion and Health Align: Mobilizing Religious Health Assets for Transformation, edited by James R. Cochrane, Barbara Schmid and Teresa Cutts. Pietermaritzburg: Cluster Publications, 2011.