Download Govt-faith - Christian Connections for International Health

Government
&
Faith
working together
E. Anne Peterson, MD, MPH
Assistant Administrator, Bureau for Global Health
US Agency for International Development (USAID)
CCIH
May, 2003
Call to Africa: Clinical Care
Anne’s Story:
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Why?
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4th Year Medical School
New Christians
Where?
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Zaire Mission Hospital
Call to Prevention
Anne’s Learning Experiences:
* Kenya
Community Health Development
* Zimbabwe
Public Health Training, AIDS prevention
* Haiti, Brazil
Elephantiasis treatment and prevention
A New Calling for Anne
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Out of the blue
Political appointment
Persistent call
VA Commissioner of Health
“You can make a Difference”
Left Kenya desiring to impact US
international health policy
Moral, ethical, policy issues
Biblical examples: Samuel, Daniel
Assistant Adminstrator, Global Health, USAID
A Vision for the Future
President’s Caring for the World
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Millenium Challenge Account:
$5B more *good governance*
Presidents Mother-to-Child Transmission
prevention: $500M
Investment in Global Fund (new ‘alliances’)
$1.3B
President’s Emergency AIDS Initiative -$15B
‘Freedom Corps’
Faith Based Initiatives: Pursuing not hindering
relationships with FBOs
USAID
Development Agency
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Both Crisis & Long term
emphasis
Program Implementation
Decentralized for inExpertise
country decision making
 Doing Programs
Partnerships:
•Global Development Alliance
•Business sector!
•FBOs
•Multisectoral work & WSSD
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Policy & Management
guidance
Operations Research:
How do you do it better?
Monitoring & Evaluation:
Did we make a difference?
U.S. Resource Flows to the Developing World in 2000:
$70.5 BN
U.S. Private Flows
to the Developing
World (FDI and Net
Cap. Mkts.)
39%
U.S. Government
Official
Development
Assistance (Part 1)
14%
Personal
Remittances from
U.S. to Developing
World
25%
U.S. Government
Other Country
Assistance (Israel,
Russia, etc.)
(Part II)
4%
U.S. Foundation
Giving Abroad
2%
U.S. Corp and
Corp. Foundation
Giving Abroad
4%
U.S. NGO (PVOs)
Grants Abroad
5%
U.S. Universities
and Colleges For.
Student
Scholarships
2%
U.S.-based
Religious
Organizations
5%
Increasing Funding Levels for
Global Health
600
$ Millions
500
400
300
200
100
0
95
96
97
98
99
00
01
02
Fiscal Year
FP/RH
HIV/AIDS
Infectious Diseases
Child Survival
USAID Bureau of Global Health
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Service to the Field
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Research
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Global Leadership
$1.8B health dollars
$1.1B manage
$400M control
USAID Global Health Programs
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Reproductive Health & Family Planning
Maternal Health & Nutrition
Child Health & Nutrition
Infectious Disease Control
HIV/AIDS
~11 Million Children Die/year
(70% From 5 Major Causes)
Malaria
7%
Other
31%
Birth Trauma
Neonatal Deaths
Tetanus
Fever
Low Birth Weight
ARI
29%
Malnutrition
56%
Diarrhea
25%
Measles
8%
Child Health
10.5 M children die/year of pneumonia, diarrhea and malaria.
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> populations of Delhi, Shanghai, Moscow, Istanbul, Tokyo & NY.
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In 5 years more children have died the combined populations of those
6 cities.
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Affordable, effective life-saving interventions
6 cents for oral rehydration therapy (ORT),
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25 cents for antibiotics to treat respiratory infections, &
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12 cents for some anti-malarial tablets
are not reaching those who need them.
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Cycle of poverty, malnutrition and infectious diseases – all sectors
impacted
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Disease impacts development & Health interventions promote
development
Infant Mortality Rate in Least
Developed Countries, 1950-2005
Infant Mortality Rate (per 1000 births)
250
200
150
100
50
0
*Medium variant projections
5*
-0
00
20
0*
00
-2
95
19
5
-9
90
19
0
-9
85
19
5
-8
80
19
0
-8
75
19
5
-7
70
19
0
-7
65
19
5
-6
60
19
0
-6
55
19
5
-5
50
19
Source: World Population Prospects, The 1998 Revision, Vol. I: Comprehensive Tables United Nations, 2000.
Infectious Diseases
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Tuberculosis prevention, control & treatment
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80% is NOT associated with AIDS, but is most common cause
of death of PLWA in sub- Saharan Africa
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Malaria prevention, control & treatment:
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child dies every 30sec
Anti-microbial resistance
Family Planning
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Maternal mortality can be reduced 20% through family
planning
Spacing births at least 36 months apart can prevent one in
four infant deaths
In Romania, a doubling of contraceptive use contributed to a
35% reduction in abortion
Largest cohort ever coming into reproductive age.
33% pregnancies unplanned & families larger than desired
Access to family planning is still a problem
Since 1965, contraceptive use has increased from less
than 10% to over 40%
Even in low resource settings prevalence has increased
dramatically, e.g. Kenya & Bangladesh
Some FBOs working in
Family Planning
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The Adventist Development and Relief Agency (ADRA)
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Georgetown University's Institute for Reproductive Health
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natural family planning services & new products
Catholic Relief Services
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family planning, education on child spacing & the benefits
of smaller families.
breastfeeding, related maternal and child dietary practices
integrating into ongoing Child Survival, Maternal and Child
Health, Family Planning, and Emergency Relief Programs.
World Vision
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family planning and child survival programs.
HIV/AIDS:
A Global Pandemic
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43 million people living with HIV and AIDS
50-69% of new infections are in 15-24 yr olds
In 2002, 5 million new infections (800,000 children)
45 million more predicted by 2010
By 2010, in 11 SSA countries over 20% of
children under 15 will be orphaned
Implementation of a full prevention package
by 2005 could cut the number of new
infections by 29 million by 2010.
The global view of HIV, end 2001
Recent trends in HIV infection, 1996–2001
+ 1 300%
+ 20%
+ 20%
+ 160%
+ 100%
+ 60%
+ 40%
HIV prevalence in adults, end 2001
15 – 39%
5 – 15%
1 – 5%
0.5 – 1.0%
0.1 – 0.5%
0.0 – 0.1%
not available
+ 30%
+ 20%
Source: UNAIDS/WHO July 2002
USAID HIV/AIDS Priority,
Basic Countries & Regional Offices
AIDS work > 50 countries
All programs >70 countries
HIV/AIDS Successes
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At project level:
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sustained reductions in risk behaviors
>> less HIV transmission
>> lower HIV & STD prevalence
At national level:
 Preventing a major epidemic
(Senegal, Philippines, Indonesia)
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Reducing an existing severe epidemic
(Uganda, Thailand, Zambia, Dominican Republic,
Cambodia)
The Agency’s AIDS Strategy
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Prevention
Treatment, ARV & non-ARV
Care & support - growing
Assisting children affected by AIDS (OVC)
Surveillance
Research
Coordinate with other donors
Engaging national leaders
New Policies in Prevention
Balanced ABC
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Balanced
approach to
prevention
Data from
Uganda,
ABC does
work
Use
Condoms
HIV
DECLINE
Delay
Sex
Debut
Sex
Partner
Reduction
Data US &
international:
Youth can &
will choose to
change
behavior
Children Affected by AIDS (OVC)
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75 activities in 22 countries
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New: Hope for Africa’s Children Initiative
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Strengthen family and community resources
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“Children on the Brink”
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joint publication with UNICEF & WHO
Scope, trends, strategies
Multisectoral Approach
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All sectors are massively impacted
All sectors can contribute to decreasing the epidemic
Fits with community-centered approach
At least 15 USAID missions have adopted this
strategy
Developed HIV/AIDS toolkits for education, natural
resources management, agriculture, democracy and
governance, microenterprise sectors
Faith-Based Organizations (FBOs)
& USAID
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USAID has long history with community- and faithbased organizations (C/FBOs)
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Missions have worked effectively with FBOs for at least
15 years on HIV/AIDS
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Survey in 2000: >10% of Africa HIV/AIDS funding
going to FBOs
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Planning for expanded work with C/FBOs began over
two years ago
Global Health
Faith-Based Initiative
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Assess & track extent of work with FBOs
Assess & overcome the barriers to working together
Materials : “how to…” get funds, do strategies
Web sites: USAID & partners
Conferences: awareness of new opportunities
Workshops: grant writing, monitoring & evaluation
Policy change: A&B, trafficking, FBO roles, strengthen
families
Legal: soften separation church-State
New, easier ways to get $
Challenges to working with FBOs
Constitutional issues: need for firewall between
secular and sectarian activities
Some FBOs not yet engaged in health
Diverse and sometimes conflicting theological
perspectives
USAID institutional resistance
USAID & FBOs: Legalities
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Discriminatory treatment against FBOs is prohibited.
FBOs may compete for funding for activities on
equal footing with all other types of organizations.
Preferential treatment for FBOs is prohibited.
USAID may finance only programs that have a
secular purpose and which do not have the primary
effect of advancing or inhibiting religion.
Value-based programs are OK. Specific scriptural
references are not.
FBOs may use their own funds for religious or
sectarian purposes.
Why Work With FBOs & CBOs?
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Geographic reach
Unmatched staying power
Well-developed infrastructure
Part of the Community
Bring People & $ resources
Multinational links
Influential leadership
Place high value on human life; personal and community
health and well-being
Can work full range of interventions & outside the
“development box”
Offer constituency-specific groups, e.g., women and girls
Why Work With FBOs & CBOs?
Can’t win the war without them!
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ABC Prevention
50% hospitals &
clinics are FBOs - ARV
Non-ARV- community
& clinic
Home Care - growing
Orphans & Vulnerable
Children, especially
community support
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Stigma reduction –
mercy not judgement
Supporting PLWHA –
“least of these”
Pastors training
“Voice” – call to
compassion, call to
righteous living
Why FBOs might want
to work with USAID?
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Funding 
Connections & Networks
Common desire to make a difference
Technical Assistance
 What has worked elsewhere
 New areas, e.g. PMCT
 Results orientation: monitoring and
evaluation (M&E)
Best ways to connect with USAID
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Apply directly to local USAID ‘mission’ in country
where you work
Apply in response to specific grant requests:
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CORE, REACH
New ones
Send USAID unsolicited proposals in Aug. or Sept.
Work with or within?
Leaders or staff
As Models
Secretary Claude Allen
Bishop Alexander Muge
As Servants
Working in Government can make a difference!
Work with us – join us!
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This is a unique time: new interest, new leadership,
new partnership & new $. Showcase FBO excellence.
There are lots of Christians in public service & in
politics but often isolated & unsupported.
We can contribute in policy & politics. If God can use
me, He can use you.
If He calls you, even to secular service - answer.
Your government represents you.
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Vote, Work with, Pray
“I glorified thee on earth, having accomplished the
work which Thou gavest me to do” (John 17:4)
Contacts
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USAID FBO website: www.usaid.gov/pop
health/aids/TechAreas/community/index.html
CORE web site: www.coreinitiative.org
Agency Faith-Based Office: Mike Magan
Global Health Faith-Based team: Kate Crawford
Resources: ABC, What happened in Uganda?
Children on the Brink