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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: Why? 4th Year Medical School New Christians Where? 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 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 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 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 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 Service to the Field Research Global Leadership $1.8B health dollars $1.1B manage $400M control USAID Global Health Programs 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. > populations of Delhi, Shanghai, Moscow, Istanbul, Tokyo & NY. In 5 years more children have died the combined populations of those 6 cities. Affordable, effective life-saving interventions 6 cents for oral rehydration therapy (ORT), 25 cents for antibiotics to treat respiratory infections, & 12 cents for some anti-malarial tablets are not reaching those who need them. Cycle of poverty, malnutrition and infectious diseases – all sectors impacted 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 Tuberculosis prevention, control & treatment 80% is NOT associated with AIDS, but is most common cause of death of PLWA in sub- Saharan Africa Malaria prevention, control & treatment: child dies every 30sec Anti-microbial resistance Family Planning 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 The Adventist Development and Relief Agency (ADRA) Georgetown University's Institute for Reproductive Health natural family planning services & new products Catholic Relief Services 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 family planning and child survival programs. HIV/AIDS: A Global Pandemic • • • • • 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 At project level: sustained reductions in risk behaviors >> less HIV transmission >> lower HIV & STD prevalence At national level: Preventing a major epidemic (Senegal, Philippines, Indonesia) Reducing an existing severe epidemic (Uganda, Thailand, Zambia, Dominican Republic, Cambodia) The Agency’s AIDS Strategy 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 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) 75 activities in 22 countries New: Hope for Africa’s Children Initiative Strengthen family and community resources “Children on the Brink” joint publication with UNICEF & WHO Scope, trends, strategies Multisectoral Approach 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 USAID has long history with community- and faithbased organizations (C/FBOs) Missions have worked effectively with FBOs for at least 15 years on HIV/AIDS Survey in 2000: >10% of Africa HIV/AIDS funding going to FBOs Planning for expanded work with C/FBOs began over two years ago Global Health Faith-Based Initiative 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 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? 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! ABC Prevention 50% hospitals & clinics are FBOs - ARV Non-ARV- community & clinic Home Care - growing Orphans & Vulnerable Children, especially community support 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? 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 Apply directly to local USAID ‘mission’ in country where you work Apply in response to specific grant requests: 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! 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. Vote, Work with, Pray “I glorified thee on earth, having accomplished the work which Thou gavest me to do” (John 17:4) Contacts 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