Beyond an Instrumental Approach to Religion and Development – Challenges for Church-based Healthcare in Tanzania

Public Private Partnerships (PPPs) have become increasingly common in global health. Since health systems in development contexts tend to be weak and fragile, they are still dependent on receiving contributions from faith-based organisation (FBOs). Hence FBOs are given increasing space in policy-making and access to contractual agreements for accessing public health funding. This dissertation is a contribution to the ongoing debate on the role of religion in development. It deals with specific dimensions of PPPs in health in Tanzania.

• Churches are still closely associated with Western donors, even though the official purpose of the PPP reform is to strengthen the partnership with public authorities.
• Church leaders challenge state legitimacy, in particular at the local level, and several church-based hospital managers in the study are critical of local politicians who instead of strengthening the pre-existing church health infrastructure advocate for the establishment of new public health facilities.
• Local governments do not deliver financial support to church-based hospitals in accordance with agreed contracts. There even seems to be ideological resistance from local governments in relation to partnerships with FBOs that most likely affects the level of funding redistributed at the local level
• There is an increased tension between the role of a critical voice and a more collaborative attitude towards the state. This could be because we are currently witnessing a shrinking space for civil society in Tanzania in general.