E. Anne Peterson, MD, MPH Assistant Administrator, Bureau for Global Health US Agency for International Development (USAID) CCIH May, 2003 Government &

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