The CHAG Model: A Blueprint for Universal Health Coverage in Africa | A Conversation with Dr. Peter Yeboah

What does it take to deliver healthcare at scale and still reach the underserved?At WHX Lagos, Dr. Peter Yeboah shares how the Christian Health Association of Ghana (CHAG) has become a cornerstone of healthcare delivery providing nearly 30% of care with just 7% of facilities.
From decades of public-private partnership to a deep focus on rural communities, this conversation highlights a powerful model for achieving universal health coverage in Africa.
It’s not just about systems, it’s about impact, equity, and collaboration.
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Transcript

SPEAKER_01 0:10

Hello, healthcare enthusiasts, and welcome back to the cure. We are live today at WHX Lagos, day one, and with me I have Dr. Peter Yeboa. He is the executive director of the Christian Health Association of Ghana, and he's also the chair of the African Christian Health Association platform. Dr. Yeboa, it's such an honor to have you here with us. Yeah.

SPEAKER_03 0:35

Pleasure too. Thank mine.

SPEAKER_01 0:37

So I have a few questions for you. My first question is just thinking about CHAG. So CHAG or the Christian Health Association of Ghana, CHAG, operates about 7% of Ghana's health facilities but provides almost 30% of the care. And Miss Injude in Delhi today said that over 70% or around 70% of the staff at CHAG facilities are actually paid by the government. So you've managed to, or CHAG has managed to be so integral to healthcare delivery in Ghana. And I believe that faith-based organizations like CHAG are so important for universal healthcare coverage. I would love to hear from your perspective the role you see in faith-based organizations in universal healthcare.

SPEAKER_03 1:27

Very well. Many thanks for the opportunity to have this exchange about the history and the rule and relevance of charg in Ghana's health sector. First, of course, if you have barely 7% of the health infrastructure with 30% output, there's a high efficiency in this.

SPEAKER_00 1:47

Yeah.

SPEAKER_03 1:48

Very well. And in fact, in some rural areas, uh we provide about 80% of the health care in some remote and rural areas. So regarding um our relationship with government, it goes back to history. Our early missionaries invested in health, education, and profits.

SPEAKER_00 2:11

Yeah.

SPEAKER_03 2:12

And upon independence, uh, the new Ghana had to rely on only the mission hospitals. Government had virtually limited or no health facilities, especially in the rural areas. So that was where the partnership came in. And so for from since 1957, the new Ghana or the government of Ghana has had that sort of symbiotic relationship with um with church-based hospitals, and that relationship has transformed into partnership. Relationship is just fluid. Partnership is when you consummate it with an agreement, MOU, for UTV, it's about integration, alignment with common values. So, and that is why SHAT has remained an implementing partner of the Ministry of Health.

SPEAKER_02 3:10

Yeah.

SPEAKER_03 3:11

That we align our priorities with that of government, we ensure that our mission and vision of a healthy Ghana or mission of promoting Christ's healing ministry improves equitable access to healthcare and ensuring that the underserved and poorly served and unserved segments of society are fully integrated. So when it comes to universal health coverage, SHAG has been the foundation of universal health coverage. Meaning that anyone living in Ghana will have access to the highest attainable quality of healthcare, irrespective of socioeconomic circumstances. And from pre-colonial era to colonial era to independence and post-independence era, we have always been located in the rural and segments. Ensure that they are well represented, and that is the equity principle. So we are not only efficient, we are also the champions of equitable inclusion for the health space.

SPEAKER_01 4:44

Yeah. I love that. And I would love to hear what you think the private sector. So there's you know faith-based organizations like CHAG, but then there's you know private hospitals as well as the government's um public-funded hospitals. What can they learn from what CHAG has built? Because, like you said, that um output is quite high. 7% versus 30% is quite a high output. And I'd love to hear what learnings you could provide for private sector, for public sector as well.

SPEAKER_03 5:17

Well, so in our African settings, there are three key players in the house in the health sector. One is the public sector, the other is fate-based, and of course, the other one is private. And within that ecosystem, all these players are vital stakeholders, they complement each other. Government says the policy, the private sector provides services, faith-based actors also provide services. They may have different orientation, different directions, but at the end of the day, the beneficiaries of the services, the private sector, and faith-based networks and government are all Ghanaians, are all the ordinary persons. And that is why inclusion into the policy space is very important. Yeah. What Child has done over the years is to demonstrate value in the health policy arena. We come out with innovations. Uh later we'll talk about some of the innovations we made that has been very impactful for Ghanaians. We also demonstrate our contribution to the entire health sector by data.

SPEAKER_00 6:40

Yeah.

SPEAKER_03 6:41

In your submission, you began by saying that Chad has barely 7% of the health infrastructure, and yet you provide a third or 30% of healthcare.

SPEAKER_00 6:50

Yeah.

SPEAKER_03 6:50

So what the private sector can let first and foremost is to align their priorities with that of government. Government wants equitable assets.

SPEAKER_00 7:04

Yeah.

SPEAKER_03 7:05

Universal healthcare coverage. Are the private sector prepared to move into the rural areas where there's a great need? Yeah. Government wants deconcentration of health assets in the cities and the urban segments. Um, are they also prepared to really uh respect that? And that leads also to the fact that the private sector is surely classified as private for profit, right? So they must break even. I think this is where the private sector should be able to demonstrate um their value, the value they bring to bear for the entire sector. So in times of strike actions, in times of challenges within the entire public sector and the rest, they are there to complement government. Yeah. And so I think the private sector should be able to document their contribution by using data.

SPEAKER_00 8:00

Yeah.

SPEAKER_03 8:01

Very important. They must be present at the policy table. If you're not present at the table, you end up in the menu.

SPEAKER_00 8:08

Yeah.

SPEAKER_03 8:09

They should have a very united, unified network system with representative voice that is able to influence policy setting, policy agenda setting. Yeah. Very important.

SPEAKER_02 8:21

Yeah.

SPEAKER_03 8:22

And they should have the soft skills of advocacy, you know, negotiations, lobbying. It is the unintended effect of being fully entitled. Doesn't work, in my opinion. But your ability to demonstrate value in partnership relationships would earn you a right at the table.

SPEAKER_00 8:50

Yeah.

SPEAKER_03 8:51

So if the private sector would wish to influence government policy, and rightly so they should. They could influence some incentive packages.

SPEAKER_00 9:02

Yeah.

SPEAKER_03 9:02

Um, asking government to incentivize locations of the operations. If you want me to go to the um the rural areas, are you prepared to give me task breaks? Are you prepared to support me with equipment so that they could also break it in for the private sector who also have to really survive and complement government very well?

SPEAKER_00 9:22

Yeah.

SPEAKER_03 9:22

I think there is the need for them to cover everything about the configuration of the private sector network.

SPEAKER_00 9:32

Yeah, yeah.

SPEAKER_03 9:34

Um they need to have a representative voice at strategic places within the policy areas. Yeah. They need to demonstrate their contributions and value to the entire health sector. Not only their contributions, but attributions. And once these um this type of interventions could be done, yeah. Configuration of who they are, the architecture of how of I mean of their relationship all together, and how they can really be influences for the good of the entire system.

SPEAKER_00 10:16

Yeah.

SPEAKER_03 10:17

I mean, definitely that would be very great. And I guess also that the language of the private sector should demonstrate, of course, they are business people, should also demonstrate some type of nationalistic attraction to something. Of course, um they should serve as bridges to healthcare services. And for me, they are vital players. Yeah, if they could be well organized to have that representative voice, yeah, to pitch their advocacy, you know, uh needs, I think they'll be able to um have a very active, focused, deliberate relationship with government.

SPEAKER_00 11:11

Yeah, yeah.

SPEAKER_03 11:12

That'll be there. The way to influence government is not to occasionally make statements. Um that might sound a bit adversarial and a bit desperate, but government needs the private sector. The private sector also needs the government. So that principle of reciprocity and mutuality should regulate how the two parties act together because I know that in every Ministry of Health in Africa there is an office dedicated for private sector inclusion to the health policy space.

SPEAKER_00 11:49

Yeah.

SPEAKER_03 11:51

How do we engage such such such an office?

SPEAKER_00 11:56

Yeah.

SPEAKER_03 11:57

And so that is what I would say that there are prospects and potentials for uh to promote the inclusion of the private sector providers, yeah, private sector, but it needs some way.

SPEAKER_01 12:09

Yeah. Um, and and you've mentioned quality a lot. You you are a very strong advocate for quality. And in the panel discussion earlier today at the leadership forum, you referenced how safe care has been adopted by all CHAG facilities, and you even said quality is the passports for market entry, which I absolutely love. I I would love to understand just how much safe care and the quality improvements have have made an impact in the way that Chag delivers care in Ghana.

SPEAKER_03 12:44

Yes, absolutely the case. Quality is always an intermediate goal of any health system. Efficiency, quality, efficiency, and and uh effectiveness, economy are all vital considerations when we want to make a health system uh more uh resilient and responsive for charges. Our mission and vision and joins us differently is to really ensure that we provide the highest obtainable quality healthcare services to anyone who calls on us for service. Why? Because as Christian faith-based organization, we want to promote Jesus Christ's healing ministry. So every client, every patient that appears before us is a representation of Jesus Christ. And Jesus Christ is a king. So if a woman comes to us, the woman is Mother Mary, she is a king. If a man comes to us, she's a king. And so the quality is a vehicle for us, it's a catalyst, it's a platform for fulfilling our mission and to promote the health and healing mandate Christ has given us. And so, as we explore how to create value and how to be impactful uh in the design and delivery of health services, we search a quality improvement tool that is all encompassing. It has 13 service elements, meaning that if you go through all the uh the safecare checklist processes, it will it amounts to a holistic review of the entire health system.

SPEAKER_00 14:49

Yeah.

SPEAKER_03 14:50

So meaning that uh it improves facilities, uh any health facility operations, strengthens the health system, it looks at service areas like elements like service provision, uh, human resources for health, data systems, logistics, medication, uh treatment compliance, diagnostics, laboratory services, um, client satisfaction, and all that all the health system golden blocks are embedded in safe carefully program. So it's not just a one-off targeted focused program, it leads to self-reflection and systemic review. And at the end of the day, it enhances what I describe as systemic enablement and strengthens capacity. What Safecare does is we have a very fair, objective, scientific way of assessing your state of quality by an independent assessor. You know, human beings by nature have our own biases. Yeah, we have our own orientations, and we can live in denial and illusion. And as I said, faith-based practice in the past often have felt entitled, uh entitled to provision of highest quality. We believe that while we have an inherent, we have a Christian heritage, we feel that we have an inherent type of you know um quality. But quality must be there's a trust, trust the social capital must be interesting so self-care comes in with reality check of states of your quality, rates and runs your quality status from one to five, five being the highest, and one being the lowest. Yeah, yeah, it's like uh the star rating, uh five-star hotel, ten star hotel. Yeah, uh level five being the highest, level one being the lowest. And when we adopted safe care, we were just shocked to realize that there are many, many gaps that we needed to fill. Yeah, we were also inspired because we saw prospects for change. We saw in safe care some form of, as I said, value differentiator, a competitive advantage. We came to realize that quality is no longer a compliance requirement, it's a strategic advantage. And so, safe care. I'm not just trying to glamorize safe care, but safe care is only helping us as a tool to do internal super objective reflection state of quality by benchmarking, benchmarking our service provision to international standards. Yeah, today you heard of several standards that are growing up. And if you really want to grow, you must look at global trends and patterns. Um, innovation is as relevant as it le as it stimulates growth and development and response to you know needs. Yeah, and so self-care is only helping us to review or evaluate the way we design and deliver service services, it is helping us to identify gaps and overlaps, it is helping us to evolve structured type of interventions to improve our health system. You know, improvement is continuous. So when it comes to quality or growth or development, it is not a destination, it is a journey. Yeah, so safe care is only a vehicle, a catalyst, seeing how we can governise that. And yeah, embedded in safe care are several incentives and sanctions. So for us, quality is indispensable, it is non-negotiable, it is a sustainability agenda for us, it's a competitive edge and value differentiator that we embrace.

SPEAKER_01 19:26

Yeah. And my last question, because our season two theme for the cure is build the rails, and we're just build the rails, and the rails are basically everything in terms of infrastructure that a health system needs to create an enabling environment. So the rails that keep everything up. You mentioned earlier that in Africa we have three sectors: public, private, and faith-based. And you sit on the you're chairing the African Christian Health Association's platform. Africa has one of the largest kind of faith-based provider networks. In your view, what role does the faith-based sector play in building the rails, building the enabling environment for innovation, not just delivery of care, but for actually innovation in healthcare in Africa?

SPEAKER_03 20:16

So let me bring that. So let me say I was a former chair, I've handed over, okay, but I was chair for six years. Okay. And so I became nuanced about the happenings in Africa and the rest. Now, um, faith-based actors, remember, have been in the system for several decades, several years. In most countries, um they have provided or they provide the foundation for health service delivery. The early missionaries uh came with three key portfolios. You find out wherever a faith-based health facility is located, opposite site, the directly opposite is a church. Yeah. On the right side, it's a school. So you see that triangular development, and they were looking at holistic development of the human person, yeah. For health, education, also leveraging the power of the pulpit. You know, the um the church leader or the religious leader has unquestionable authority and captive audience. And so beyond that, faith based also have other assets like interfaith platform. Yeah, so they use the education space, health space, the church space, and that of interfaith platform for to highlight innovations. They do community mobilization, pilot innovations, they have trust, which is the highest social capital they have. Yeah, because they are uh they have a sense of you know that humanitarian.

SPEAKER_01 22:00

connection and there is yeah they easily they're easily accepted by folks in the communities yeah and it is these assets that faith based actors have used in some countries in my own country ghana you know ghana now pride itself as having a very functional national health insurance scheme with 66 percent of the population uh registered coverage it was Chag that pioneered and highlighted community based health insurance scheme yeah and provided proof of concept and then the government politicians saw it and they nationalized what faith what we have yeah so we so of course for us we are not in competition with the government yeah we are rather in collaboration yeah yeah um we don't we um we promote partnership or the child partisanship and so we happily supported government to embrace or to take over the community based health insurance schemes we set yeah because we felt that it would it had become a public good could transform the entire health sector and we could switch our role now to become the provider and promoter of you know of a quality based health insurance scheme yeah there and so faith based actors can be innovators yeah innovators of of you know of impactful change because they are trusted to also attract investments yeah in whatever they do of course we are look we are moving in an era where investors are also looking for returns on the investment yeah and so faith-based actors are now uh at a place where you can always highlight innovations because they are not constrained by bureaucracy red tapism within the government system so they are able to implement policies they are devoid of partisan politics yeah yeah they are neutral habitants they are advocates and because they are located mostly in the communities yeah they are able to conceive the real needs of community yeah actors yeah they are respected they are trusted and the rest so the faith based providers have such relevant role in the entire health sector they provide stability in my own country when government sector is on strike faith based institutions do not go on strike yeah of course sometimes they are skirmishes but the fact is that our institutions are functional once government may come and go yeah we provide stability yeah our church leaders have seen healthcare services as an integ as as a as integral part of the evangelization portfolio yeah so what it means is that the health and healing ministry that faith based actors you know I mean uh entrusted with will continue to be there until the kingdom comes despite changes and challenges yeah so our role is well vested in our faith in our values in our beliefs yeah and in our mission as promoters of Jesus Christ's holy ministry yeah and so remember we are also the the passionate advocates of the poor and needy the under self segments we always promote inclusion diversity and equity in health policy arena so we bring that moral conscience and ethical perspective yeah the formulation of policies yeah wow I think this conversation has kind of solidified in my mind that when we think about build the rails we have three main rails public private and faith based and I think people tend to overlook the faith based rail but everything you've described has just proven to me it is a rail it is a place for innovation and it's serving the needs of of the people um and meeting the need where the need is so thank you so much Dr. for speaking to us um speaking to our listeners we really appreciate it thank you all right pleasure bye bye