E' Anne Peterson, MD, MPH

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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
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Call to Africa Clinical Care

• Annes Story
• Why?
• 4th Year Medical School
• New Christians
• Where?
• Zaire Mission Hospital

3
Call to Prevention

• Annes Learning Experiences
• Kenya
• Community Health Development
• Zimbabwe
• Public Health Training, AIDS prevention
• Haiti, Brazil
• Elephantiasis treatment and prevention

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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
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A Vision for the Future

• Presidents 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
• Presidents Emergency AIDS Initiative -15B
• Freedom Corps
• Faith Based Initiatives Pursuing not hindering
  relationships with FBOs

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USAID

• Development Agency
• Both Crisis Long term emphasis
• Decentralized for in- country decision making

• Program Implementation Expertise
• Doing Programs
• Policy Management guidance
• Operations Research How do you do it
  better?
• Monitoring Evaluation Did we make a
  difference?

• Partnerships
• Global Development Alliance
• Business sector!
• FBOs
• Multisectoral work WSSD

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U.S. Resource Flows to the Developing World in
2000 70.5 BN
U.S. Government
Official
U.S. Government
Development
U.S. Private Flows
Other Country
Assistance (Part 1)
to the Developing
Assistance (Israel,
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World (FDI and Net
Russia, etc.)
U.S. Foundation
Cap. Mkts.)
(Part II)
Giving Abroad
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4
2
U.S. Corp and
Corp. Foundation
Giving Abroad
4
U.S. NGO (PVOs)
Grants Abroad
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U.S. Universities
and Colleges For.
Student
Scholarships
2
U.S.-based
Personal
Religious
Remittances from
Organizations
U.S. to Developing
5
World
25
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Increasing Funding Levels for Global Health
600
500
400
Millions
300
200
100
0
95
96
97
98
99
00
01
02
Fiscal Year
FP/RH
HIV/AIDS
Infectious Diseases
Child Survival
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USAID Bureau of Global Health

• Service to the Field
• Research
• Global Leadership

1.8B health dollars 1.1B manage 400M control
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USAID Global Health Programs

• Reproductive Health Family Planning
• Maternal Health Nutrition
• Child Health Nutrition
• Infectious Disease Control
• HIV/AIDS

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11 Million Children Die/year (70 From 5 Major
Causes)
Malnutrition 56
Birth Trauma Neonatal Deaths Tetanus Fever Low
Birth Weight
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Child Health

• 10.5 M children die/year of pneumonia, diarrhea
  and malaria.
• gt 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

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Infant Mortality Rate in Least Developed
Countries, 1950-2005
Infant Mortality Rate (per 1000 births)
Source World Population Prospects, The 1998
Revision, Vol. I Comprehensive Tables United
Nations, 2000. Medium variant projections
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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

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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

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Some FBOs working in Family Planning

• The Adventist Development and Relief Agency
  (ADRA)
• family planning, education on child spacing the
  benefits of smaller families.
• Georgetown University's Institute for
  Reproductive Health
• natural family planning services new products
• Catholic Relief Services
• 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.

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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.

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The global view of HIV, end 2001
Source UNAIDS/WHO July 2002
outside region
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USAID HIV/AIDS Priority, Basic Countries
Regional Offices
AIDS work gt 50 countries All programs gt70
countries
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HIV/AIDS Successes

• At project level
• sustained reductions in risk behaviors
• gtgt less HIV transmission
• gtgt 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)

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The Agencys 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

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New Policies in Prevention
Balanced ABC
Data US international Youth can will choose
to change behavior

• Balanced approach to prevention
• Data from Uganda, ABC does work

• 
  
• 
  
• 
  

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Children Affected by AIDS (OVC)

• 75 activities in 22 countries
• New Hope for Africas Children Initiative
• Strengthen family and community resources
• Children on the Brink
• joint publication with UNICEF WHO
• Scope, trends, strategies

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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

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Faith-Based Organizations (FBOs) USAID

• USAID has long history with community- and
  faith-based organizations (C/FBOs)
• Missions have worked effectively with FBOs for at
  least 15 years on HIV/AIDS
• Survey in 2000 gt10 of Africa HIV/AIDS funding
  going to FBOs
• Planning for expanded work with C/FBOs began over
  two years ago

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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 AB, trafficking, FBO roles,
  strengthen families
• Legal soften separation church-State
• New, easier ways to get

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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

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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.

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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

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Why Work With FBOs CBOs?

• Cant 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

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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
  (ME)

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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.

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Work with or within?
Leaders or staff
As Models
Secretary Claude Allen
Bishop Alexander Muge
As Servants
Working in Government can make a difference!
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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 174)

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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