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
Annes Story:

Why?
4th Year Medical School
New Christians

Where?
Zaire Mission Hospital
Call to Prevention

Annes 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

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
 USAID

Development Agency
Both Crisis & Long term
emphasis Program Implementation
Decentralized for in- Expertise
country decision making Doing Programs

Policy & Management

Partnerships: guidance
Global Development Alliance Operations Research:
Business sector! How do you do it better?
FBOs Monitoring & Evaluation:
Multisectoral work & WSSD Did we make a difference?
 U.S. Resource Flows to the Developing World in 2000:
$70.5 BN
U.S. Government
Official U.S. Government
U.S. Private Flows Development Other Country
to the Developing Assistance (Part 1) Assistance (Israel,
World (FDI and Net 14% Russia, etc.) U.S. Foundation
Cap. Mkts.) (Part II) Giving Abroad
39% 4% 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%
Personal U.S.-based
Remittances from Religious
U.S. to Developing Organizations
World 5%
25%
 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

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% ARI
29%

Other Malnutrition
31% 56%
Birth Trauma
Measles
Neonatal Deaths 8%
Tetanus
Fever
Low Birth Weight
Diarrhea
25%
 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

250
Infant Mortality Rate (per 1000 births)

200

150

100

50

0
19 19 19 19 19 19 19 19 19 19 20
50 55 60 65 70 75 80 85 90 95 00
-5 -6 -6 -7 -7 -8 -8 -9 -9 -2 -0
5 0 5 0 5 0 5 0 5 00 5*
0*

Source: World Population Prospects, The 1998 Revision, Vol. I: Comprehensive Tables United Nations, 2000.
*Medium variant projections
 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)
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.
 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, 19962001
+ 1 300%

+ 20%
+ 20%
+ 160%
+ 100%

+ 40% + 60%
HIV prevalence in adults, end 2001
15 39% + 30%
5 15%
1 5%
0.5 1.0%
0.1 0.5% + 20%
0.0 0.1%
not available 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 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
 New Policies in Prevention
Balanced ABC
Balanced Data US &
international:
approach to
Youth can &
prevention will choose to
Use
Condoms change
behavior
Data from
Uganda, HIV
ABC does Delay
DECLINE
Sex
work Sex Partner
Debut Reduction
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
 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 faith-

based 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?
Cant win the war without them!
ABC Prevention
Stigma reduction
50% hospitals & mercy not judgement
clinics are FBOs - ARV
Supporting PLWHA
Non-ARV- community least of these
& clinic
Pastors training
Home Care - growing
Voice call to
Orphans & Vulnerable compassion, call to
Children, especially righteous living
community support
 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