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tv   Discussion on Faith- Based Global Health Care Efforts  CSPAN  August 31, 2015 2:00pm-2:56pm EDT

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innovative finance mechanisms and contracting, from your country they spoke at the conference yesterday and actually challenging faith-based health care delivery systems. to formalize and strengthen their mechanisms. in fact he kind of challenged them to say the mous you have are not worth the paper they're written on. and pushing people towards more contracting. on faith side i think it's up to us to step up to offer more robust collective organizations that bring us together in larger scale so we can deal as collective bodies not just small institutions with governments so they can achieve the scaleable objectives in terms of development. those are some thoughts. >> thank you. and andrew there was one more question for you between differences of religions that you saw. >> yes.
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that was an interesting question. you asked about whether there was any differences between the written theology as opposed to a more verbal one. yeah, the main face that we looked at obviously did have a written. what we didn't look at, and we've actually referred to this in the paper, was the enormous richness of traditional faiths and certainly i can speak mainly in africa, but i'm sure the truth is in asia where the faiths have been there for years and sometimes in a sink syncrotistic way. more modern faiths such as christianity and islam, we didn't look at those because the diversity of those would have needed a lot more work. all we could see was a very
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interesting thing, was that there was a considerable enthusiasm among all of the faith leaders for seeing how they could be more involved and actually there was a great opportunity expressed in the work that we did for making faith leaders more aware so that their sacred teachings, the preachings about traditional values could actually have a very clear health content and they could be part of the action rather than just leaving everything to the health professionals. i don't know if that answers the question at all. but that is how we saw it. >> thank you. we're closing in on the end of the hour unfortunately. maybe we have time for two more questions and short answers in the panel. any other -- any other questions? okay. well, i will ask each of you on the panel, you've done such amazing work and given us so much to think about.
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i would like to hear from you in summary what you would like to see as the next steps as a result of your work that you've been -- that you've put so much effort into the research and the writing, and not necessarily relating to the piece you've written, but how you would like to see this play out, so jill? >> as someone academy and immersed in evidence, that is what i'm hinting at at the moment. and someone made the comment about the lancet, by having these papers in here, signaling something in terms of the broader discipline and i'll give you an example. we hosted a conference on the health systems conference in cape town and there were 2,000 people there and there were only two faith-based conferences and
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it is a signal to the fact that these issues come up in conferences, we have separate conversations about faith and faith-based providers but they are rarely integrated into the broad health public development agenda and conversations and my hope would be rather than this becoming a stand-alone conversation, it gets more strongly integrated into the broader public health and development conversations. >> great. andrew. >> yeah, i see this series and the amazing meeting that has just been on religion and sustainable development being a start of a place in which things can have markers. i'm just a boring academic but i do get enthusiastic from time to time and the markers should be gained in terms of donors and
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health providers in terms of how aware are you and how much are you being inclusive. many have been exclusive. and what jill is talking about in the paper, how inclusive are you of faith-based groups in policy and programs and it is possible to look at policy and international agencies and see how well they are coping with the challenges that this paper puts forward. similarly i would see that the faith groups have -- they've made some wonderful responses in the last 10, 20 years, particularly in the area of hiv care. but there are many other examples. but how do the faith leaders actually become more aware of how their teachings can actually interface most profitably in association to build these partnerships up and they too --
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i don't think they've ever been subject to peer review and monitoring and evaluation. but the peer review process is a very interesting one with the faith leaders and the theological colleges, all of the colleges that are churning out faith leaders, it is very interesting to see if they could become more faith aware because that does give enormous potential for changing the societies which are hurting at the present time. >> one of our presenters at the conference yesterday, david sutherland, who is working in the philippines challenged the conference with the notion of how do you measure hope and dignity. i think that our challenge -- our real opportunity now is to build on the growing interest by virtue of the scale of the ambition of the goals, the develop goals, the growing interest on the part of policymakers for engaging all
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hands in the development tact and therefore also being very open to engage in faith-based assets. our opportunity now is to pull together the evidence frame that shows to them that our work and our contribution will help achieve and help drive development outcomes and i think we need to do that in creative ways. a lot of evidence already exists and i think that we need to underscore and get much more creative at communication. and in the end of the day, i think that a lot of our work going forward is about building friendship and trust that will allow us to cross the cultural divides that we addressed earlier in the remarks in the paper. >> thank you. >> thank you, all. and again thank you to the lancet, for publishing this important series and opening the discussion, which will go on. thank you very much.
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[ applause ] >> thank you all. in the interest of time, we're going to dive right into the second panel which will give us an opportunity to look at the u.s. angle and the u.s. engagement with faith-based organizations and the genesis of those strategies and what impact and evolution we can see. and we are honored today to be joined by three very respected panelists, we have sandy thurman to my left who is the chief strategy officer for the office of the global aids coordination and many of you know sandy from her long work in this arena. and in the middle we have mark frank mueller the director of the center for faith-based initiatives at usaid and janet
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kates at the kaiser family foundation. you have their full bios in the handout so i won't go into all of the details, but you can see that we have a very -- a very important panel up here and we are eager to dive into some interesting discussion on this. i think we all know in the first panel made very clear the importance of engaging with and understanding the role of the faith-based communities in providing global health, in providing information, especially in reaching communities, the poorest of the poor, the hard to reach areas. i'm reminded of a time not long ago when i was in it ethiopia and interviewed an orthodox priest and we were talking about family planning and i asked him what message he gave to his followers and he said roughly translated, family planning
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isn't a sin. hungry children is a sin. and it is just a fascinating lens through which we can see against the importance of faith leaders and the information they can transfer to their communities in engaging them and ensuring they have the information and the capacity that is necessary to reach their communities with appropriate and accurate information. we have been engaging in some very interesting conversations on this subject. most recently last week with some faith providers from kenya on the subject of family planning. so i think it is true what the first panel really emphasizes, that things are evolving and developing and this is an important moment to be exploring this further. and with this panel we're eager to talk about it from the focus of the u.s. policy perspective. and i think to begin with we'll turn to sandy thurman. given your long involvement with hiv policy from the u.s.
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government, can you describe to us more about how pep far began partners with faith-based organizations and how that has evolved. >> sure. thank you. and thank you all for being here. it is interesting, the faith community has been a partner in response to hiv since the beginning of the epidemic, both domestically and globally. so i think pet far was an out growth with faith-based organizations on the domestic side for a number of years. when we really began looking at the disproportionate impact of the epidemic in africa back in the late 1990s and early 2000, it was a lot -- our interest and a lot of the pressure that was brought to bear on the u.s. government and policymakers was from faith-based organizations who were on the ground in africa seeing the devastation that was
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occurring on the continent. so they've been a natural partner for us, faith-based organizations and faith backers have been a natural partner with those of us working in the hiv and aids response from the beginning. so when we began to expand the global program to focus on hiv internationally and to put this in perspective when i was actually working in the white house our global aids budget had been $125 million a year. for seven years in a row. which now of course is a rounding error and our program. so when the interest started, faith-based organizations were at the forefront of encouraging us to respond in a very robust way. and that, of course, ultimately
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led to -- to the development of pet far. but i would add that the faith-based partnerships were -- were not based on politics. they were based on pragmatism. people on the ground that had access and trust in the communities, all of the things that we knew we needed and partners in pep far, they were a primary and natural for us. >> it is so interesting how all of this has evolved and we'll get into more of the spectrum of groups and the challenges and opportunities that that has presented. but that leads in perhaps in for mark to tell us about your office at u.s. aid. what is the goal and what is your out reach and your strategy. >> sure. so i have the great privilege to head this office at usaid and its origin is back around 2003
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under the bush administration and trying to do a more systemic and engagement with the faith community. that said we've been working with faith groups since the inception of the agency 52 odd years ago so this wasn't new to the agency it was a new way of looking at it and to reach out to a broader group of partners and that is a guiding star for the agency. if you think about buckets of work, certainly to be the ombudsman into the agency, the sherpa, the groups that want to work with usaid and don't know how to get into the door of bankruptcy, can come to us. groups can act like an ombudsman, we can help finding facilitations for faith-based and community groups and try to do proactive out groups, so around ebola as a recent example. we organized with the white house and the department of state a conference call with faith-based actors across the united states and we had 400 people on that call to talk about ebola and the role the faith-based community might play and we did smaller groups in d.c. with 30 or 40 organizations.
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so there's a convening role of the organization. and supporting the other parts of usaid trying to get things done. so we support the missions in their engagement and that is a critical part of aid. for a big government agency we are decentralized. our missions are vital and decision-making happens much there and so those are all of the ways this we try to put it in and we try to make it our engagement in the faith community as robust as possible especially when there are areas like health in emergencies, when the faith-based community have unique things to bring to the table. >> thank you. one of the things that came up, in fact, on the last panel, was how much of the share of the u.s. government support goes through faith-based organizations and so many of us turn to kaiser for that kind of analysis and i wonder, jen, if you could tell us more about how that -- how much kaiser has approached that and why that is a complicated set of numbers to find?
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>> thanks, janet. and i just want to say that i want to commend the lancet and the authors who put this issue together to start where we pick up and formalize an evidenced based framework that is so critical that i don't think has existed at this level at looking at faith-based organizations and health. and so for this question and what we ask at kaiser, what happens now and what is the scope of the involvement and mark and i were talking in advance of this and clearly money is just one measure of this. there is many more ways to look at involvement. money is one that we all care about and pay attention to and so in preparation for thinking about that question i will share some data that we just looked at and really good work being done now on this. researchers and others looked recently at health and there's an article that came out on this
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roughliest mated that over the last decade or more 30% of all health system for health has been channelled through faith-based organizations. that's a complex analysis. there is a lot there but i encourage people to look at that article in plus journal, so that is available online. the other piece of work of done is jean's work looking specifically at the share of revenues that faith-based organizations have that are from u.s. government sources and she found 13%. so i think it is less than people think in their minds. so in preparation for this panel, i took a look at data we recently released around nongovernmental organizations. another broad area that faith-based groups don't know about, what is the role of ngos and we put out a couple of reports on this and we put out a summary analysis on this and what do we know about faith-based organizations in that framework and we looked at
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2013 data, 2014 is just available now. but 2013 data, disbursements by usaid and there is caveats there and just looking at that year, we were able to identify that faith-based organizations represents about 15% of ngos that receive disbursements of global health. so 15% of ngos were faith boised. and it is good to look at historical analysis and see how that has changed. and faith-based organizations within the ngo's community were working in africa, not a surprise to those of us here but an important data point. and the area they were most likely working in was hiv and malaria was a big one and malaria and hiv than ngo's over all, less so than family planning. we like to look more in depth, but to give you a sense. in africa, and malaria and probably less funding than people think. i will give you the funding amount because i can see people
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wondering what that amount is. it was about $96 million in 2013, for what -- to give you a sense. that is less than the global fund amount identified in the ihme analysis. >> we're going to run through a series of questions and come back and give you a sense to interact with each other. perhaps linked to this, the question of who are -- who are these organizations and where are they and what are they working on, sandy, you have described from your long years of works the spectrum of the kinds of organizations that helps to underscore the opportunities and challenges of working with them. perhaps you could talk more about what you mean when you talk about different approaches needed for different kinds of faith-based organizations? >> sure. thank you.
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i think this is -- this is a genesis of some of the challenges we've had around building these partnerships between faith-based organizations and governments, because it is hard to -- to -- if we say faith-based organizations, that means a lot of things. faith-based organizations can range from anything from the catholic health system in the united states of america which is still -- and i'm using the u.s. as an example, which is still the second largest health care system in the country to very small clinics or ngo's or orphans or children on the ground. so there is an incredible broad range. differences in capacity, very big differences in ability to deliver services. and so i think our challenge, all of our challenges to both donors and to faith-based organizations is to begin to define with greater specificity and communicate what the differences are for people.
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and it certainly came up a lot in the meeting held at the bank this week and has before. and i think when we look at revamping our mechanisms, in order to be more effective, build more effective partnerships, we have got to be able to name those things so that when we have partnerships and define roles and responsibilities and establish monitoring and evaluation and accountability and mechanisms and so forth, we have to be very clear about what we are doing with and it can be very big or very small. but what you don't want to lose in that is that we know from all of our years in public health, that if we want to really look at sustainable change at the end of the day, that -- and we want to be able to have countries take full responsibility and ownership of the work that is being done in their countries, that that has to be rooted -- on
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the ground in grassroots organizations all over the country. so if we want to sustain the impact that we've had in pepfar or look at sustainability development, we have to figure this out. so we need to stay at it until we do. it won't be easy. it is like family dynamic, it is not easy, but you don't abandon the family, you stay in there and work at it and that is where we are in this conversation and it is very exciting. >> it is interesting, because one of the pieces of sustainability, which is of course a big theme here in washington and everywhere, is also the link to the private sector. and the longer term financing issues that link to sustainability. and mark, you have talked about the added financial value of working with faith-based organizations and the outreach. can you describe a little bit more about your outreach to faith-based groups as a link to the private sector? >> sure. i think there are two elements
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of this. one is that faith-based organizations like most nongovernmental organizations have robust fund raising, largely from the private sector and they have partnerships via boards and other mechanisms in which they've been engaging the private sector since they've existed and had to do that. the other is a more directive to say as we're looking at the importance of the private sector in development, health care in particular, one way we can think about the faith community, the business people motivated by faith but will never put a religious icon on what they do. for example, there is a project they are working on at u.s. aid about to be finalized on health, a small health experiment to see if business principles can provide sustainability in provision of health care and clean water and others in the eastern democratic republic of congo and a consortium of business leaders connected to
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the national christian foundation in the united states have put up a million dollars of that partnership that we're working together. and the national christian foundation, the philanthropy that flows through every year is hundreds of millions of dollars. part of that will go to international activities. we haven't formalized partnerships with that kind of flow to capitalize as well as the expertise within that community to bring it to bear and i think that is fertile ground to build on. >> jen, you've done a lot of work over the years on the u.s. response to the aids epidemic of course, and as we discussed in the first panel and in the lancet piece, we saw the importance of some of the faith-based organizations roll in that response as well as the ebola response that was touched on also in the first panel. do you want to reflect a little bit more on your view of how that has had an impact in u.s. response? >> sure. to pick up on something sandy said about the role of faith-based organizations and the faith community and hiv from day one, that is clear in the
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u.s. domestic case as well as globally but i also think it is really important to note that from the case study perspective of pepfar, how did pepfar come to be, when we come back and try to look together what are the elements that went into many of us watching the state of the union speech and hearing $15 billion and wondering how we were able to get there. it is clear without the faith community, that wouldn't have happened. so the faith community was from a case study the pepfar, to making pepfar happen. so it is not just on the ground delivering services and being partners but it really is pushing the u.s. government to go to another level. so i think that is just really important from my perspective, looking at it from the long-term. on the ebola response, it is pretty clear that without engaging the faith community, the way governments had to do, realizing they had to or we would not have been able to turn
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around that crisis. and hopefully the lessons from that experience will be evident and ready -- not just back on a shelf, but the next time a crisis like this occurred, whether it is ebola again or something else, it is at the forefront of this approaching communities with cultural understanding and engaging the leaders in the community that understand them and can speak to them is the only way we can really get ahead of this. >> it is quite clear there has been huge, huge impact and benefit and also very big challenges that have been presented by the engagement, particularly from the pepfar perspective. sandy, could you talk about some of the hardest parts of pet far's history in dealing with the faith community and what lessons have been learned and how has that impacted the current pepfar strategy? >> sure. i think that -- and again it was
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not new with pepfar. we've had challenged and in hiv and aids with the faith-based communities and incredible opportunities from the beginning. but it was certainly true. and pepfar, i think that we've had to -- a couple of things. i think it has been very hard for a mechanism as big as pepfar to find a way to operationalize our partnerships with faith-based organizations on the ground. and so that has been one. and then we've had stumbles around and challenges around issues of reproductive health, around the lgbt community and we've seen that play out in recent days. but i think where we hang on this, interestingly, it more in places like washington, d.c. and in our big institutions rather than on the ground. what i have found always so inspiring is the way that people who are actually on the ground doing this work figure out a way to work together.
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and oftentimes we at headquarters and policy making bodies -- we try to make it better, but sometimes i think we make it worse. because people are so -- people are creative, especially people who are working on the ground in very hard to serve populations in the far reaching places in the world. the people figure this out. i think this is the place where we need to learn from colleagues on the ground and bring those lessons learned up to the top. there is something that dr. blevins mentioned, that we have to be careful in wanting to be so politically correct and in the way we engage as policymakers that we don't put people at risk. so we want to tell the story about the nuns who are buying office supplies for an ngo that is secular so they can trade and get condoms and not get caught by the bishop, in the old days
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and people figuring it out on their own, i think we need to take lessons from our colleagues on the ground. it continues to be a challenge for us. but the other thing that we talked about is finding common ground. and again, when we define with specificity what our roles and responsibilities are when we engage in a partnership, like a pre -- i don't know why i'm using marriage metaphors, but a prenup, but we know this is what we are bringing and you can't touch this and i'm not going to touch all of that, and we have to define with greater specificity how we engage and i think it takes mystery out of this if you have secular institutions and faith-based institutions. if you really dig down up front and define with greater specificity you can find the common ground and not put each other at risk any in way. >> and to be specific, we have some real controversies that
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have emerged, like in uganda, and would you like to hear from mark about that episode, putting the lgbt community at such risk, the funding for the interreligious council being drawn because of that and what lessons were learned because of that and what new practices or vetting procedures or new mechanisms arose from that? >> i think i should summarize first just quickly, legislators within uganda proposed an anti-homosexuality act that was draconian at best in terms of treatment of lbgt people and the description and of who they were
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in terms of people was beyond pale. and the members of the religious council campaigned positively for that legislation and vocally took out ads in the paper, spoke at a huge rally and i was in uganda when this rally went on and you are listening to think and thinking this is just such a horrible situation and i think the u.s. government lost confidence in the interreligious council to carry out the mandate and serve people without bias. it was so beyond the pale of what we normally saw in terms of actively campaigning, among all of the interreligious council members. all of them were for it. so funding was withdrawn from that institution and mechanisms were put in place to meet the need of people in uganda so they weren't left without treatment. in terms of lesson learned, i think that situation has become polarized. i come out of a community organizing background, when you polarize you have to figure out how to depolarize.
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i don't know that we have done that succescessuccessfully yet. how do we depolarize. and the other thing i think we need to learn more about what the actual discrimination is on the ground so we have the evidence that said yes this rhetoric links to a set of behaviors happening that are impacting people negatively. we don't know that right now. we make assumptions that are reasonable but in other cases there have been religious leaders at the top saying bad things but providers on the ground continuing to do good work. so we need to figure that out. there was a study that usaid did about bias, and i think that is a model for what we want to do in other places and replicate that and what people are experiencing and what they perceive to be experiencing and what can we witness they are experiencing. >> certainly another area of challenge involving family planning and reproductive health and, jen, i wondered if you wanted to talk about what you have seen in terms of how that has played out.
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>> and to pick up where mark left off around lgbt rights and the issues that happened. there is a good new study looking at nigeria and the perceptions of gay men on the ground and their ability to get services and what they needed, finding a link between the rhetoric and their own fears about seeking services, but i agree, getting that evidence and summarizing it for policy makers and program managers can understand is really very, very critical. and something that goes to the family planning issue that actually i want to paraphrase that ambassador burke said that overriding issue for policymakers is really about public health. so it is the public health approach. what works for public health. and as she said much more
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eloquently and i'll paraphrase. stigma, discrimination in any form is not what public health and human right is about and cannot help us in response to hiv. and stepping back, i think the polarize is around family planning is very clear in washington. and i think what happens is that people don't realize or make assumptions that faith-based communities are not champions of family planning when many, many are, in fact, leading on providing family services on the ground. that is the evidence -- for that is there. so there is a sort of mischaracterization often of the community and it is a diverse community so that also doesn't work as a characterization. i think where the challenges arise is that when there are effective services such as modern contraception being most effective in terms of women who want family planning methods should get according to public health evidence and if there are faith-based organizations and others who can't or won't provide that service, it is incumbent upon the u.s. to look
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and do an assessment and say how do we reach those who need the services the most and what is the best way to do that and that is where the emphasis needs to be, from the public health perspective and reaching the goals and how do we reach those who need the services most and put that together from a government perspective. >> i know we're going to have a lot of questions from the audience, but i wonder, sandy, if you could talk for a minute about how does all of this fit into pepfar 3.0. >> i think it fits squarely into pepfar 3.0. and we know we're going to have to going forward take a very strong public health approach to containing and eliminating the epidemic in ways that -- not that we didn't do before but now that we have limited resources, more people on treatment, we've got to continue to move forward, and we're really going to have to focus more and more as time goes on. that is very important.
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our best partners -- some of our best partners and doing that work are the faith-based partners because we have to get into communities and access those relationships of trust to get people into treatment to keep them on treatment, all of the things that we know that we have to do that it often takes time to do in developing relationships and getting into communities and getting people who needs services and getting them into treatment and keeping them in treatment, we can't do that on our own. so we have to find the partners already in the community to help us do that. so expanding our partnerships with faith-based organizations is a critical part of that. and it comes down to -- it is very pragmatic from a public health perspective. we have to identify folks and get them in treatment and keep them in treatment and the programs have to be rooted in communities and on the ground. and this has to be
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sustainability. it is the primary partner and a big piece of our work going forward. >> mark, you've talked about exactly that issue, the sort of cultural literacy, i think i call -- you called it, training for u.s. government agencies to work better with fbos if we're allowed to use the term for now, including new training for how to work with religious groups. can you just say a word about what that entails? >> sure. so general frame is that the various agencies of the u.s. government came together in the past few years and there is an interagency strategy on global religious leader and political engagement. part of that strategy calls for more training within our agencies, cross gofts -- government on how to work with faith-based organizations. at u.s. aid we've received money from the u.s. capitol team, basically our h.r. department, to begin to do that within our
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missions and things and so that is really going on for us very strongly. so i have a team, a member of my team, who has worked with many of you, pamela staples who is leading the effort, to do more training and sensitivity. i would say also, if the other side of the coin is how do the take based organizations provide the literacy training toward working with government 101 and 201 and 301, which we all know is a challenge of its own. >> thank you all. i have a lot of questions but i think you do too. so let's open it up. and again we'll take three at a time. and please identify yourself and your brief question. and then we'll do another round after that. so please wait for the mic so that our online viewers can hear you as well. so first question. >> hi, thank you.
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i'm john blevins from emory university. jonathan mann put forth the perspective that human rights have to ground the moral perspective and the work of a lot of what we're talking about here and that has been an important concept and an important kind of grounding for a lot of our work. but in our work, at least in kenya, with faith-based organizations that work with member who have sex with men, work in lgbt communities and with men who use drugs and they almost never use the term. and they talk with us and a lot of us know this, that around contentious issues the term invoking human rights has an effect of being seen as the west trying to impose cultural values on another part of the world. but our faith-based partners invoke their own similar kind of teachings to do similar kind of work. one of the things i found powerful at the world bank
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meeting is dr. kim out of the poor and roman catholicism it feels to me around finding a common moral space on contentious issues that there are intersections we haven't explored very much and i know faith-based leaders are working to do that in various parts of the world and i wonder if you have any thoughts as to how we might understand those kind of common moral grounds that give us new language beyond just the language of human rights, now abandoning it but expanding it. >> and we have a question in the back corner. >> denise, open house systems. how much -- when a usaid, or whoever funds these programs, are they also attaching to it the sufficient funds to do the evidence based analysis of the intervention as well and are
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they making that -- it seems to me like in the first part, we were talking about evidence based interventions and faith based and obviously funding for that kind of analysis is also important and how much is that attached in the packages? >> one more question for this round. >> all right, let's turn back to the panel. we have two very interesting questions. one, first let's take the human rights question and then going beyond -- extending -- including human rights but going beyond that term. sandy, do you want to start off? >> sure. again, there has been some really interesting work done over -- on this, better language and better words and defining the way that we -- that we talk to each other about these kinds of issues. but it's limited. and i think coming out of the
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conference, and we've had a lot of dialogue about this coming out of conference yesterday, i think it is clear that we need to spend some time looking at expanded kinds of language that works for everyone and that is not polarizing in and of itself. we all respect and i'm sure jonathan mann who was just an extraordinary visionary in our field, but understanding that we have to -- our language has to change as time changes. we're not still -- we have to keep moving on and finding common language as more partners come to the table. i think it is something we need to invest in and we really -- and a conversation i would love to have with colleagues going forward. and for us in pepfar and for others. because again if the partnerships are going to work like we need to work we have to invest in figuring out what the -- what the foundation of that looks like and then come to
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some agreement on that. >> jen, maybe you want to come in on this issue of universality of human rights and the impact of language here. >> language is critical. if you don't speak the same language as somebody, you have to work on understanding. so how are people -- people speak about a situation or a group is clearly -- there has been a lot of work done on that. i completely agree that figuring out the right way to frame these discussions with different communities is -- we have not done a good job of it. i do wonder though about the human rights using that language. because when the uganda and nigeria situations were at their height, i was involved in a lot of conversations with people in d.c. as well as in africa about how to approach it that these were harmful laws and one of the discussions that kept coming up
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were lgbt rights or human rights and someone said you have to focus on human rights and that will speak to a whole sector of society that will not necessarily be part of an lgbt rights discussion. so i don't think it is clear. it depends on communities and there are religious leader where's human rights language is the language they use. but to your point, we have not cracked this nut at all. >> can i say, on this -- a resource i don't think we have used enough were -- or a place a turn is our foreign service nationals which are the people from the countries in which we are working who work for usaid for a long period of time, decades often. and they are rooted in their own communities and they are from the religion we are talking about and they have the set of relationships and when foreign service officers rotate after a short number of years and i've come to appreciate in my three years my role and how to work
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with the foreign service nationals to address the question of language, perspectives and relationships. >> and mark, maybe you want to take the first crack at the question about funding for the evidence. >> where you get into that is difference between evidence and evaluation. and certainly we're there on evaluation. that is built into the requirements of our funding. we don't tend to fund a lot of evidence. and that is a gap. and i don't know where we're going to solve that. we talk to kenya -- our budgets are largely dictated by capitol hill and so maybe it is a conversation there as well. but we're good on the evaluation, not so good on evidence. >> sandy? >> i think this is really a place where we as government donors are slightly schizophrenic because we keep asking for evidence and demanding evidence and talking about data and then we box ourselves in to only having -- monitoring the evaluation that mark talks about.
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i think that is a conversation we really need to have and it is not an easy one because again we are all funded by the u.s. congress and we have our own sort of challenges around that. it is also a place where i think that advocacy on the part of our faith-based partners could be very helpful for us, to say that there is -- we have all of this anecdotal data, but we're ham strung by the fact that you are asking for evidence that we can't pay to get and see if we can't be a little bit more creative in these conversations with our colleagues down the street to see if we can't find a way to do that, or external partners that appreciate the need for evidence, foundations and other donors who might not be as restricted as we are. >> and i neglected to give a positive story. usaid has funded the institution
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of reproductive health at georgetown millions of dollars to look at the efficacy of fertility beads for family planning purposes. and there has been evidence now that those do work. they are efficacious and so we can fund those as a tool to use to reach our goals in family planning. obviously we're going to have a whole lot of other tools. but that particular tool is acceptable by many religious groups opposed to the other tools. and so i think that is one positive story that we might look at replicating. >> do we have other questions from the audience? right here in the middle. >> hi. my name is jana carp, i'm hear from the state department. and it has come up a couple of times in terms of the ebola crisis in west africa but i was wondering if you could speak more generally about the role that faith-based groups could play in pandemic preparedness and response and sort of lessons learned from ebola in the past
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year, two years. >> other questions? >> again, my name is rosemary, i just go back to the cooperation, how do we cooperate and i met president bush before he left office in the faith-based initiative in 2008 and we talked about the same thing. how do we come up with this collaboration of outreach, advocacy in the rural areas there in africa and as you say, lessons learned on ebola because there was no outreach or education to people. so local people feels -- do so much work on the ground but nobody gives them credit and nobody funds them so we should look at the cpos and the local
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faith-based organizations in the rural areas, the small organizations do a lot, so u.s. aid, pep fund, and look into that and work up from the ground and we do collaborate. again, thank you. >> if there are no other questions we'll turn to the panel for these two. again, the question of the role of the faith groups in pandemic preparedness. >> i think that it's -- well engaging faith-based organizations and emergency preparedness and pandemic preparedness is critical. again, we've done that domestically and as we look at system strengthening, it is difficult for us to do it on a global -- with global reach as it is -- than it is to do at home with domestic reach. but certainly faith-based organizations and other private
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actors have to be partners in any kind of emergency preparedness or pandemic preparedness and i think people are very aware of that, certainly in the aftermath of the ebola epidemic and the of aftermath of the ebola epidemic. and the faith based organizations were on the ground responding to the epidemic responding before anyone else could figure out what to do. what's coming up in our conversations is also training our first responders. on how to engage with people who are already doing the work on the ground when they arrive. and so the transfer of -- and the partnership and the integration of already on the ground indigenous services is done in a way that honors the people who are respobding first, and engages the people who are our first responders coming from big organizations and multilaterals and donors and others. so we have a lot to learn, but
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there's no doubt i think from cdc's perspective or others, that faith based partners have to be a big part of that process. >> i totally agree, the preparedness side of the equation, the response to crisis is much easier, but just what will be important is to look forward, to what extent are faith organizations and leaders involved in preparedness now. there's been so much more attention to the need to have that preparedness because of ebo ebola, there's new money available for that. in 2013 i was just looking back, there is a funding line that u.s. has looking at emerging threats. very few get money in that regard and there's reasons for that, none of -- no faith based organizations got disbursements for that in 2013. this is preebola.
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it will be important to look at that going-forward, i think. >> one story, you're thinking, whether you work with small groups or not. the former administrator met with a small orphanage in school that had to basically shut down, needed food to feed many of their students. this is a small operation. it also turned out that the pastor that ran this had a national radio show that covered the country. at first glance was small, became very big, he was able to send messages out, and was widely respected. we have to be open to being surprised and being careful when we think something's small. i also think we are -- in terms of the second phase of ebola response, we want to build back better. the international part of the catholic health association, seeing if there's a way we can
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partner about ebola, ending childhood preventable deaths, i think that's a key to try to reach some of these organizations. in terms of doing health systems strengthening across the board with faith and nonfaith. to build in the resiliency, and take these shocks and not get set back so far. >> any thoughts on the collaboration piece. we talked a lot about that up until now, but any last thoughts? >> i think again we have to continue to expand our capacity. the big governments will never have the capacity to directly fund very small organizations, it's just not -- i mean, we don't have the band width to be able to do that, as much as we would like to, it's often where
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we get the best return on our investment, we'll continue to rely on robust coordinating mechanism mechanisms so we get the money on to the ground. it's the way to i.d. their funding. it's the best of what we got at the moment, there's always room for improvement, and part of what we're talking about going-forward is how do we improve these mechanisms and increase our capacity to get closer to the ground. >> i think in the last couple minutes, i'd like to ask you, what are the next steps, including to address some of the hard issues, the paper and the ones that we talk about, the challenges, about child marriage, about gender, about family planning and reproductive health.
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there are some really big issues the u.s. government is focused on in its own strategies, and sometimes the faith community can help in those strategies, and at times they are a barrier to implementing u.s. goals in that area, when you're thinking about next steps, please include how to address these big challenges. jen, do you want to start us off? >> sure. >> looking at the next phase of the health policy, global health more generally. the articulation we have to reach -- we can't have the world we want if we don't, faith based communities have always done that in a way that other groups haven't been always able to. we can'te


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