Catholic Missionaries and Their Work with the Poor

Mitigating Market-Government Failure in Emerging Nations

Albino Barrera

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367029180
• eBook ISBN: 9780429671319
• Edition: 1
• Topic: Theology & Religion
• Subtopic: Christian Church

This book explores the vital role of faith-based organizations (FBOs) in compensating for the market's and government's inability to provide vital services. Its key theoretical contribution is the notion that poverty is the result of a triadic failure—when markets, government, and civil society become dysfunctional at the same time. Using data on Catholic missionaries' development work, this study presents the various ways by which FBOs mitigate market and government failures in healthcare, education, and social services, and in the process build and strengthen civil society.

This study has two main objectives. First, it aims to present an overview of missionaries' development work, evaluating the socioeconomic significance of their faith-based development work. In addition, various comparative advantages and disadvantages have been imputed to FBOs in the religion-development literature, and we assess to what extent missionaries actually exhibit these posited qualities in practice. Second, the groundwork is laid for future religion-development scholars by presenting a theoretical framework and a method for evaluating the role and contributions of FBOs in the larger community.

This is an important investigation of contemporary worldwide Christianity and its relationship with development. As such, it will interest scholars of religious studies and missiology, as well as development economics, public service and the political economy.

1 Missionary healthcare services and their outreach to the ultra-poor

What services does our sample of missionaries provide?

About a third of our sample of over 1300 projects are in healthcare. Table 1.1 shows that we have a little over 300 medical facilities, to wit: hospitals, health centres, HIV/AIDS centres, homes for the disabled, leprosaria, nutrition centres, hospices, and shelters for the elderly. In addition, we have schools for nursing, midwifery, and pastoral healthcare. Our sample also has specialized medical facilities, such as substance abuse rehabilitation centres, non-drug therapy centres, a pharmaceutical depot, an orthopaedic training centre, an obstetric fistula centre, top-of-the line bio-molecular laboratories, and a tuberculosis facility. In addition to these medical institutions, we have over 90 healthcare programs, such as nutrition supplementation, HIV care, home-based care, palliative care, and outreach to the disabled.¹

Not all of these facilities and programs are funded or owned by the religious institutes in our sample. Some are owned by or receive funding assistance (including medicines) from the state. These are examples of greater openness on the part of governments for more public–private partnerships in the provision of services in post-secularism.

This wide range of services and institutions reflects the diversity of missionaries’ target beneficiaries and their respective needs. The infrastructure and equipment are just as varied, from hospitals that are among the best, the most modern, and the most reputable in the country with top-of-the-line equipment,² all the way to remote rural hospitals that struggle with primitive facilities in the most isolated and impoverished areas.³ There is a clear preference for community-based healthcare services. Care and prevention of HIV/AIDS are front and centre for our sample of missionaries.

For the rest of the chapter, we assess the beneficiaries of such healthcare, what is distinctive about these services, and what is their socioeconomic significance based on what we know from development economics.

Table 1.1Missionary Healthcare Initiatives

Hospitals	47
Health centres/dispensaries	91
HIV specialized	32
Institutions for the disabled	42
Educational institutions	15
Leprosaria	18
Hospices	5
Mobile clinics	29
Nutrition centres	5
Shelters for elderly	23
Special medical institutions	22
Total medical institutions	329
Medical programs
Home care	27
Special medical programs	60
Medical disabled programs	2
Nutrition programs	6
Total medical programs	95
Total of healthcare initiatives	424

Whom does our sample of missionaries serve?

The impoverished

In describing their respective ministries, missionaries in our sample note that they serve people who are impoverished both at a personal-household and at a communal level. Most missionary healthcare sites are in poor rural communities or in slums. The populations served are predominantly subsistence farmers, herders, labourers, and their families. They are said to live in indescribable poverty. Besides the project descriptions, we can corroborate the poor state of the communities through the missionaries’ first-hand accounts of their own experience of hardships in setting up their mission stations and convents in the midst of the people they serve. In recounting the obstacles they face, we get a glimpse into the living conditions within the communities themselves. These often include the lack of water and other amenities like electricity. They also talk about the remoteness and the long distances they have had to travel. Their requests to the motherhouse or congregational headquarters for water filters, diesel fuel and generators for electricity, solar panels, heavy-duty vehicles, and water tanks, among others, are quite revealing of the host communities’ poverty and lack of basic services.

Furthermore, the type of additional, non-health services provided by the missionaries also reveals much about the communities’ overall condition. We can infer this from the need to provide nutrition supplementation, literacy classes, empowerment support groups, assistance for income-generating activities, and many other similar services.

The type of medical conditions treated, such as tuberculosis (TB), malnutrition, stunting, anaemia, diarrhoea, parasitic infections, leprosy, and others, also says much about the socioeconomic circumstances of the people served. High child, infant, and maternal mortality rates are also tell-tale signs of poverty. Health facilities that are described to be the only ones providing basic health services (such as maternal and child healthcare) in their area reflect the isolation and the poverty of the locale. The type of services requested by the communities themselves also says much about their unmet needs. All these corroborate the project descriptions on the impoverished state of many of the communities served.

Similarly, we can corroborate the impoverishment of the beneficiaries at the individual-household level. Fundraising appeals from missionaries in the field disclose much about the socioeconomic state of the people served. We find requests for the purchase of medicines that would have to be given for free or be heavily subsidized because of the people’s inability to pay for them. We find requests for the operational expenses of hospitals and health facilities.⁴ Similarly, requests for the upkeep and refurbishment of these medical facilities reveal that missionaries in the field are unable to set aside funds to take care of the depreciation of their structures and equipment. Annual reports from some of these medical facilities show that patient fees are only a small part of the total operating income. This means that beneficiaries are unable to cover the cost of the services they receive. In addition, we find funding requests to repair, rebuild, or construct entirely new huts/homes for impoverished families. Calls for extra funds to pay for transportation fare (to go to the big hospitals), food, and other necessities reflect the inability of the people served to satisfy their basic needs. For example, the Camillians discovered that providing healthcare services at their 100-bed hospital in Ashotsk, Armenia, the only one available for the entire area, was not enough. The needy came to the convent and hospital asking for food and clothing. Thus, in one year, for example, in addition to 20,000 kilos of medicines and medical equipment shipped from Italy to this hospital, the Camillians had to request additional aid that came in the form of 29,000 kilograms of milk powder, rice, and pasta and 10,000 kilos of clothing. This gives one an idea of the scale of the unmet need.⁵

We can also infer the poverty of the people through the annual reports and the policies of the health centres. For example, hospitals have had to absorb the cost of unforeseen caesarean sections or from new-borns requiring extended hospital stays. Families would not otherwise be able to pay for the treatment of these unexpected childbirth complications.⁶ Missionaries have also discovered the price sensitivity of families to maternity delivery. Health facilities are in a bind in terms of satisfying two competing goals: (1) the need to be financially self-supporting as much as possible and (2) the need to encourage maternity deliveries in these facilities rather than at home for the sake of the mother’s and infant’s safety and health. Finding a balance between these two has been elusive. Raise the prices too much, and mothers take the risk of just delivering at home either because they want to save the expense or because they do not have the wherewithal to pay the fees.

The Comboni Sisters experienced this dilemma first-hand at their Bebedjia Hospital in Chad. Because of the price increase, more women had chosen to give home deliveries, and it was only when the childbirth turned out to be more complicated than they had anticipated that they went to the hospital. By then, it was often too late because the child was already dead in the womb, and the mother was completely exhausted and most likely also already at great risk. The sisters’ solution was to keep the prices for maternity delivery low so as not to discourage mothers from using the hospital, and then to ask external donors for donations to subsidize these services via the congregation’s fundraising arm.⁷

Missionaries have chosen to err on the side of operating in the red and getting mothers to have a safe delivery at the health facilities. Despite being in operation since 1981, the Daughters of Charity’s Saint Vincent de Paul Hospital in Dschang, Cameroon, still have to offer discounted prices. At least 15% of its services have to be provided for free. The impoverished state of the community precludes the hospital from being able to support itself. As it is, the sisters have to ask donors for funds to perform the most basic maintenance work on the hospital’s infrastructure.⁸ The Comboni Sisters at their hospital in Wau, South Sudan, faced the quandary of ensuring that their workers received just recompense, even as they tried to delay raising prices as long as they could.⁹ Indeed, the price sensitivity of people, even for a service as vital as healthcare, is a sign of their hard economic conditions.¹⁰

Another indication of the poverty of the families served is the frequent discovery that their children are at nutritional risk. Health centres have thus been compelled to initiate nutrition supplementation interventions.¹¹ In some cases, not only the children received these supplements. Mothers, too, who were found to be undernourished were given nutritional assistance.¹²

Low human capital

We can infer the low educational attainment and the lack of skills of the people served through the type of additional services provided by the health facilities. In particular, there are large educational components in their services, from basic hygiene, to self-esteem programs for women, to workshops on life skills, to counselling, to livelihood training, and to literacy classes, among many other services aimed at improving their human capital.¹³ The need for and the prevalence of these types of additional services are reflected in the fundraising appeals coming from the field pertaining to educational programs.¹⁴

The geographically isolated

Geographical remoteness is another characteristic of the beneficiaries of missionary healthcare services. These are people who have had no access to healthcare at all and who simply had to resign themselves to living life with their chronic debility because of the absence of healthcare services, until the missionaries came. Take the ...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• Prolegomena
• 1 Missionary healthcare services and their outreach to the ultra-poor
• 2 Missionary educational initiatives for children and youth at risk
• 3 Missionary social services and their positive externalities for development
• 4 Missionaries’ “last-mile” comparative advantages
• 5 Summary and evaluation
• References
• Index