E. Anne Peterson, MD, MPH Assistant Administrator, Bureau for Global Health US Agency for International Development (USAID) CCIH May, 2003 Government &
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E. Anne Peterson, MD, MPHE. Anne Peterson, MD, MPHAssistant Administrator, Bureau for Global HealthAssistant Administrator, Bureau for Global HealthUS Agency for International Development (USAID)US Agency for International Development (USAID)
CCIH May, 2003CCIH May, 2003
Government
&
Faith
working together
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:
* KenyaCommunity Health Development
* ZimbabwePublic Health Training, AIDS prevention
* Haiti, BrazilElephantiasis treatment and prevention
A New Calling for Anne
Out of the blue Political appointment Persistent call
“You can make a Difference”Left Kenya desiring to impact US
international health policyMoral, ethical, policy issues Biblical examples: Samuel, Daniel
VA Commissioner of Health
Assistant Adminstrator, Global Health, USAID
A Vision for the FutureA 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
Program Implementation Expertise
Doing Programs Policy & Management
guidance Operations Research:
How do you do it better? Monitoring & Evaluation:
Did we make a difference?
Development Agency
Both Crisis & Long term emphasis
Decentralized for in- country decision making
Partnerships:•Global Development Alliance•Business sector!•FBOs•Multisectoral work & WSSD
U.S. Resource Flows to the Developing World in U.S. Resource Flows to the Developing World in 2000: $70.5 BN2000: $70.5 BN
U.S.-based Religious
Organizations5%
U.S. Universities and Colleges For.
Student Scholarships
2%
U.S. NGO (PVOs) Grants Abroad
5%
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. Government Official
Development Assistance (Part 1)
14%
Personal Remittances from U.S. to Developing
World25%
U.S. Private Flows to the Developing World (FDI and Net
Cap. Mkts.)39%
Increasing Funding Levels for Global Health
0
100
200
300
400
500
600
95 96 97 98 99 00 01 02
Fiscal Year
$ M
illi
on
s
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)
Malaria7% ARI
29%
Measles8%
Diarrhea25%
Other31%
Malnutrition 56%
Birth TraumaNeonatal DeathsTetanusFeverLow Birth Weight
Child Health10.5 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
0
50
100
150
200
250
Infa
nt
Mort
ality
Rate
(p
er
10
00
bir
ths)
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.
Source: UNAIDS/WHO July 2002
15 – 39% 5 – 15% 1 – 5%
0.5 – 1.0%0.1 – 0.5%
0.0 – 0.1% not available
HIV prevalence in adults, end 2001
+ 100%
+ 1 300%
+ 60%
+ 160%
+ 30%
+ 40%
+ 20% + 20%
+ 20%
Recent trends in HIV infection, 1996–2001Recent trends in HIV infection, 1996–2001
The global view of HIV, end 2001
USAID HIV/AIDS Priority, USAID HIV/AIDS Priority,
Basic Countries & Regional OfficesBasic Countries & Regional Offices
AIDS work > 50 countriesAll 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
Use Condoms
Delay SexDebut
Sex PartnerReduction
HIVDECLINE
Balanced ABC
Balanced approach to prevention
Data from Uganda, ABC does work
Data US & international:Youth can & will choose to change behavior
New Policies in Prevention
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 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
Can’t win the war without them!
Why Work With FBOs & CBOs?
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?
Bishop Alexander Muge
Secretary Claude Allen
As Servants
As Models
Working in Government can make a difference!
Leaders or staff
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
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