Panel C1: Christian Perspectives on Health Dimensions of Debt and Other Macroeconomic
Issues
The Christian Voice on Debt Relief and Resources for Health [Mara Vanderslice,
Jubilee USA Network]
Jubilee USA Network (formerly Jubilee 2000 Campaign) is concerned with forgiveness
of debt owed by the developing world. Debt cancellation one of the most pressing
social issues today. Four times more money issued for servicing debt than
is used for health service expenditures in many poor countries. $200 million/week
is leaving Africa to service debt.
Part of the solution for AIDS has to come from debt relief. World Bank and
IMF have reduced debt by 27% for African countries so far, but it's not enough.
Many countries spend more on debt than on health. Reduction is not enough.
The next step is to cancel 100% debt cancellation from the World Bank and
IMF.
Research shows that debt relief has had an impact on health and education:
- School enrollment
increased from 40% to 90% in Uganda because of debt relief.
- Vaccinations
in Mozambique increased to nearly 95% because of debt relief.
- In Cameroun,
voluntary counseling and testing, behavior change, education, and condom
distribution all increased as a result to debt relief.
Using Debt Relief to Expand AIDS Control Efforts, the Uganda Experience [Moses
Dombo, World Vision, Uganda]
Uganda was carrying $4 billion in debt and has received $1 billion in debt
relief. Funds in debt relief have been used to improve education. Primary
school attendance increased from only 2.9 million children before debit relief
to more than 7 million children. Population with access to safe drinking water
before debt relief, only 30%, increased to > 60%.
FBOs account for much of the education and health services provided in the
country. In prior administrations this accounted for 70% of services, now
down to 40-50%; Uganda is becoming more self-reliant.
The World Bank has established a $500 million fund for African countries
to fight HIV/AIDS, and its President has promised that any reasonable project
will be funded. The question is the advisability of lending to people who
are going to die. Moses stated, "Others told us not to take money from the
WB because it is an 'evil institution.' I say, get whatever you can from wherever
you can and use it."
Partnering with Faith-Based Organizations on Macroeconomic Policies Affecting
Health [Katherine Marshall, World Bank]
Currently involved in developing a "World Faiths Development Dialogue,"
a program launched three years ago at a meeting jointly chaired by the President
of the World Bank and the Archbishop of Canterbury, and aimed at bringing
forces to fight poverty and improve dialogue on macroeconomic and other issues.
The effort takes positive inspiration from the remarkable trust of poor people
in faith leaders and institutions and faith based work in poor communities,
and reflects the experience of dialogue around the Jubilee 2000 Campaign.
The WFDD, or Center for Faith and Development, as it will be known, engages
nine major faith traditions globally and works in several countries, always
with a focus on poverty. The effort has not been smooth as there are questions
from several governments about the appropriate relations of the World Bank
with faith institutions. The fight against HIV/AIDS is a central focus of
strategic discussion and the WFDD/CFD is seeking ideas on how to move ahead
effectively.
Discussion Points:
Cost-recovery policies as a conditionality of debt relief were briefly addressed
with one participant stating that their mission health institution struggles
with the issue because not all people can afford to pay for their health care.
Mr. Dombo remarked that most people were willing to pay a fee for health service,
but they often have to make choices. Sometimes they are able to pay for a
consultation, but then are not able to afford the exorbitantly priced prescribed
medicines.
Arguments about the unfairness of the imposition of "structural adjustment"
conditionalities attached to debt relief by the World Bank were also brought
up by one participant. The World Bank responded that fiscal responsibility
of governments has become an important issue. She also stated that conditionalities
only work if the local people genuinely believe that they will and support
them, and that they don't work if they're imposed.
The World Bank also stated that the challenge is in bridging the gaps in
the dialogue (helping communication) between religious leaders, bank people,
politicians, and people "on-the-ground" (in the field), and in getting the
communication back from the field to the leaders again.
Panel C2: Motivating the American Church to Respond
Mobilizing Resources and Fundraising for Christian Programs [Lee Owen, MAP
International]
A recent poll of Americans showed that evangelical Christians were significantly
less likely to express support for AIDS education and prevention programs
or interest in helping children orphaned because of AIDS than generally helping
underprivileged children overseas. Mainline church attendees, were also surprisingly
uninterested in helping AIDS-related organizations.
MAP has been trying
to engage the American church in the fight against AIDS since the late '80s.
In 1989, MAP developed a "kit" of materials including manuals, fact sheets
and statistical information, bibliographic resources, a video, and activity
suggestions - which proved a dismal failure. The interest on the part of
the church and other faith-based communities since the AIDS conference in
Durban, South Africa is heartening and long over-due.
Interest in AIDS on the part of large foundations (i.e. the Gates Foundation)
and on the part of "Mom and Pop" foundations, both Christian and secular
is also growing.
The American church
can learn a valuable lesson from its African church counterparts in the way
in which the spiritual, mental, physical and emotional elements are addressed
as a whole in their religious traditions. An effective Church AIDS ministry
- both here in the States and overseas must address the totality of the person's
needs.
The World Relief Strategy and Experience in Mobilizing US Churches for International
Health [Adele Dick, World Relief]
There are several important trends in the church today: 1) the church wants
a giving strategy and wants their gifts to be strategic, 2) the church wants
to know the number of people making decisions for Christ as a result of their
giving, 3) the church wants their gifts to be country or people-group specific,
4) each church/denomination wants their own mission and missionaries, and
5) the church wants to be personally involved and not just give money.
Interdenominational Malaria Prevention Coalition [Gail Bingham, PCUSA]
The PCUSA bednet projects have been such a success that WHO has encouraged
PCUSA to develop a coordinated malaria prevention program with other denominations.
The PCUSA bednet projects called on the support of church women's groups in
the U.S. who raised money and sewed thousands of bednets. PCUSA has encouraged
participation in malaria prevention projects by focusing on the health benefits
of bednets for children and pregnant women. This past Mother's Day, PCUSA
introduced the concept of an ecumenical malaria prevention project by offering
Mother's Day cards to fund bednets for pregnant women; more than 3,000 cards
were sent out. PCUSA 's experience has shown the need for projects that people
can relate to and which demonstrate that their support can make a difference.
Stand with Africa [Kenlynn Schroeder [Lutheran World Relief]
Lutheran World Relief (LWR) works in relief and development through partners
in other countries. Their newest campaign is called "Stand with Africa." This
is a joint three-year project with the two major Lutheran Church bodies in
the U.S. to build awareness about realities in Africa, root causes, and to
share success stories. The project was launched by inviting Samite of Uganda
to perform a concert at the Kennedy Center in February. The major goal of
the project is to support partner's work in treatment and prevention of HIV/AIDS.
The first year will concentrate on HIV/AIDS, the second year, peace-building
and reconciliation and the third year will promote economic justice and food
security. LWR appeals to churches to support the "Stand with Africa" campaign
by prayer, study, advocacy, and contributions for the campaign.
Discussion Points:
These kinds of projects need accountability for credibility by showing
what has been accomplished. Churches are more open to having people speak
and people respond if they know and can relate to the situation. Churches
need to link with other churches and develop a continuity of action. It is
disturbing to realize that people in the US think that people in Africa are
beggars; we need to communicate that they are brothers and that they want
to work together with us.
Panel C3: Christian Perspectives on Gender Dimensions of AIDS, Malaria, &
TB
An HIV Positive Marriage and Family's Experience: Defining Gender [Brigitte
and Kabanda Syamalevwe, Zambia]
Kabanda: We have 11 children between the ages of 3 and 30. My life with
Brigitte during our 25 years of marriage has forced me to redefine gender.
This is a big issue because of the culture in Zambia. I was the first born
of the first wife of my father. My mother dissuaded me from taking more than
one wife. My life became about empowering my wife because there is a saying
that "If you educate a woman, you have educated a nation; but if you educate
a man, you have educated an individual." The goal of the program we have
is to provide men and women with skills.
Brigitte: Mine is a personality that was built on confidence. I am married
to the son of a chief. I was raised in the strictness of church structures.
My husband encouraged me to continue my education. How does the church deal
with gender issues? Emotional dependence will not allow for empowerment. In
a session I attended 32 women were encouraged to go home and ask for sex.
2 succeeded and 30 were beaten and that's it. There is so much regarding gender
that needs to be worked out in the African context. …Where are women in the
church? Gender is threatening. We need compassion and equal opportunities.
I was infected in my marriage bed. I was faithful to my husband and yet I
am committed to my God and to my family. I will use this for His glory, but
I was very angry.
Women's Health Issues and the Church [Delores Friesen, Associate Professor
of Pastoral Counseling, Mennonite Brethren Biblical Seminary, Fresno, CA]
Based on a trip to 10 African countries to assess the situation regarding
the church and HIV/AIDS, there were stark differentials in access to care
and education based on gender, age, and geography. For example, girls are
5 times more likely than boys to be infected at ages 15-19. Many women of
childbearing age carry unending guilt and anxiety about passing the virus
on to their children and then have to watch their children become HIV positive,
waste away, and die without having enough resources to influence the outcome.
Many times women also have less power than men to protect themselves from
infection. More girl children leave school to become caregivers for their
parents who are dying of AIDS; some at a very young age. Older women are also
faced with enormous grieving and care-giving tasks with the loss of their
adult children, plus caring for their orphaned grandchildren, at a time of
diminished health and strength that makes it almost impossible to survive.
If we expect men
to respond differently to women, we should ask ourselves about their upbringing.
How do women and men influence their sons and daughters? Child rearing is
one way to challenge power differentials and cultural patterns. How can we
change behavior and gender roles? Both genders are responsible.
Discussion Points:
Women need to be more involved in politics and governance. They also need
to empower men to empower themselves to eliminate the fear that men may experience.
Panel C4: Church and Government Donor Partnership and Christian
Advocacy
The Benefits and Pitfalls in Church-Government Partnerships, Examples from
Southern Africa [Frank Dimmock, Presbyterian Church, USA]
The church provides 35-100% of health services in Africa. There needs to
be an effort to formalize the relationship between facilities and government.
This has been successful in Lesotho, where the process to decentralize into
a multi-sectoral system has effectively included church-based facilities.
The challenge
is to assure that governments are better informed about the magnitude of
church facilities and appreciate their potential in national health programs.
The comparative advantage of these facilities is that they have been in communities
the longest and target the poorest people in the hardest to reach places.
Democratic Republic of Congo Experience and SANRU
Model of Church-State Partnership [Dr. Mukengeshayi Kupa, National Coordinator
for the Control of Onchocerciasis, DRC and Dr. Franklin Baer, Senior Advisor
to SANRU III]
The Democratic
Republic of Congo (DRC) has a long and successful history of collaboration
between church and government in the management of decentralized primary
health care services. This collaboration, which began in the 1970s, exists
at four levels, community/health facility, district/health zone, national,
and international. In particular the management and co-management of health
zones by NGOs, especially by the health ministries of the Protestant and Catholic
churches, has been a key to successful decentralization in DRC.
This model of collaboration rests on:
* Dialogue :
The dialogue is established between the Ministry of health and NGOs. So NGOs
are implicated in the implementation and development of primary health care
according to the vision of the government.
* Respect of roles
: Government defines
global vision, objectives, strategies and mobilizes resources. NGOs respect
these roles and bring necessary resources to help achieve national objectives.
These resources are managed by NGOs.
* Credibility
: The international organizations trust NGOs because of their credibility.
The presence of the NGOs is an important financial support for the development
of primary health care.
The SANRU (Santé Rurale) Basic Rural Health Projects I and II (1981-1991)
were managed by the Protestant Church of Congo (ECC) on behalf of the Ministry
of Health and USAID. SANRU successfully provided a comprehensive mix of technical,
material and financial resources to develop 100 decentralized health zones
in DRC. Most of these health zones were managed or co-managed by church groups.
SANRU III (2000-2006) is providing similar assistance to 80 health zones.
One key to the success of SANRU has been its "project of projects" approach
that encourages "middle-out" planning, capacity building and program ownership
by health zone teams in consultation and collaboration with community representatives
and regional authorities.
Models and Examples of Effective Christian Advocacy [Michele Sumilas, Global
Health Council]
In the U.S., the church is proving to be a highly effective advocate for
development activities. Jubilee 2000 was led by the church to raise awareness
about debt relief. Christian groups have also moved congress to support hunger
relief. They are now mobilizing to advocate for support for AIDS in Africa
through the Global Health Act.
The AIDS Initiative of the Ecumenical Advocacy Alliance [Dorothy
Brewster-Lee, Presbyterian Church, USA]
The Ecumenical
Advocacy Alliance is working to sensitize and mobilize both churches and
community-based groups to address HIV/AIDS. Through strategy groups this
body has prioritized resource mobilization and utilization and a minimum
package of health care (health being a human right) with special consideration
for women, youth and children at risk by either omission or commission.
The need for
such a movement was highlighted and promoted by the World Council of Churches
at the February UN Prep Conference for the UN General Assembly Special Session
on HIV/AIDS in order to help the faith-based voice to be heard.
Panel C5: A Christian Response to the Poverty-Disease Nexus
Realistic Strategies for Addressing Health in Poor Communities [Shobha Arole,
Comprehensive Rural Health Project, Jamkhed, India]
The daughter of missionary parents, Shobha Arole shared candidly her observations
of her parents as they served the health needs of the poor in Jamkhed, India.
Their efforts resulted in work to improve water safety, agricultural strategies,
income generation, and legal rights especially for women).
The program has evolved to take health care to the homes of community members.
It also impacts almost every aspect of people's lives. The process is one
of community empowerment through Christian values.
Congregation-based Community Health [Dorothy Brewster-Lee, Presbyterian Church,
USA]
A historical
overview of Presbyterian involvement in international health was given. The
growing gap between rich and poor changes the nature of community-based health
care efforts emerging out of congregations.
Successful efforts require 1) concerned members advocating for the poor,
2) tithing churches, 3) praying churches, 4) long-term commitment and effort,
and 5) ability to recognize recent world changes.
Christian Hospitals, Reviving the Legacy [Dr. Cherian Thomas, General Board
of Global Ministries, United Methodist Church]
This presentation
illustrated the history of Christian mission hospitals and an assessment
conducted by the Methodist Church to evaluate the effectiveness of 8 hospitals.
The results
indicate that the facilities need to be revived in the areas of governance,
leadership, management, and resources. Planned interventions have been designed
to address the needs of each hospital individually.
A Biblical Exegesis of the Poverty-Disease Healing Nexus [Rev. Gary Gunderson,
Director, Interfaith Health Program, Emory University]
Brief comments at the end of the session included a challenge to health
professionals to reframe current practices holistically. The professional
input contributed by health science research points to an understanding of
multiple factors in etiology of disease and health. He reminded attendees
that the role of love and hope as health determinants is very important.
Plenary 3: Funding and Partnerships between Donors and Technical Agencies
and Church-related Organizations, and Presentations on Policies and Programs
with Faith-based Organizations by Major Donors [Buck Buckingham, USAID; Nelle
Temple Brown, WHO; Dr. Elil Renganathan, WHO; Calle Almedal, UNAIDS]
USAID has always done a lot of its work through partnerships with faith-based
organizations (FBOs), although not much of it has been with indigenous FBOs.
Approximately 10% of USAID monies go through FBOs. FBOs are their most effective
partners because of their staying power, their unique position in the center
of communities, and their ability to reach those who are difficult to reach
or poorly reached by civil society programs. A program of "empowerment grants"
of $5000 and under is being established and guidance will be forthcoming soon
to all conference participants. They will require simple letter applications.
In two to three years they expect to be able to more easily fund projects
from $100k-$150 annually for two to three year periods. USAID must carefully
observe separation of Church and State, and its funds may only be used for
secular purposes.
The oldest area of international cooperation has been in health. WHO is
not principally a funding agency; they develop norms and standards, drug
lists, protocols for therapy of certain diseases, convene meetings (to promote
partnerships), and provide technical assistance to governments (to get the
science to the leaders so they can make informed decisions). WHO [Renganathan]
also sees its role in social mobilization and training to change behaviors,
e.g. the "Stop TB" program. WHO recognizes that FBOs are an important segment
of the NGO community/civil society engaged in health work and can make a
valuable contribution as partners to scaling up response to diseases such
as HIV/AIDS, malaria, and TB.
UNAIDS works with civil society and FBOs. The World Association of Girl
Guides and Girls Scouts is partnering with WHO to jointly create health facts
sheets on HIV/AIDS that will be used and monitored in five countries. Partnering
with Red Cross/Red Crescent will help to decrease the stigma associated with
HIV/AIDS simply because people take RC/RC seriously.
The CDC has financially supported some church-based AIDS organizations, both
in the USA and overseas.
Discussion
Points: One
participant expressed the difficulty of obtaining funding from USAID because
of the lack of training to navigate the currently difficult process. USAID's
response is that they are simplifying the process and recognize the need
to help build capacity among partners. Another participant asked about how
to keep biblical messages separate in order to obtain USAID funding. The
responses indicated that FBOs have principles that are also good health principles;
those are ok. If it is a question of using funds to proselytize, then that
is inappropriate for funding. World Relief explained how they
successfully obtained funding to create health messages that reflect and
are consistent with their faith principles. Funding through partnerships
between FBOs and government and international agencies require transparent
accounting. Those with a proven track record will be more easily recognized
for funding from the new Global AIDS Fund.
Plenary 4: Why and Way: The Living Spring of Health and Healing Ministries
[Rev. Gary Gunderson, Director, Interfaith Health Program, Emory University]
John 5:1-7…"Seek the welfare of the city and that is where we will find
our welfare." This forum allows us to get away from the Christian "happy"
talk about how good things are. TB, malaria, and HIV/AIDS keep us from this
"happy" talk and challenge us to ask, " Why and how we are called to address
them." Even the medical knowledge we have is not enough and systems are threatened.
John 5:2-15… "Do you want to be healed?" No access to care. Jesus accepts
the answer without recrimination and heals the man. The religious leaders
at the time objected because it was the Sabbath. People want to be healed.
"We are most like God when we love what God loves."
Transformation is forward moving, whereas healing is the process whereby
things are returned back to a former state of healthiness. Scripture does
not say, "Pray that the city has everything fixed in it."
There are 4 practical considerations for transformation: 1) show up, 2)
pay attention, 3) act at some cost, and 4) tell the truth about what you've
experienced. Jesus paid attention to people, patterns, and the system in
which they exist. This is a lifestyle to which we are called.
Special Lunch Session: Transforming Communities [Shobha Arole, Comprehensive
Rural Health Project, Jamkhed, India]
Shobha presented
an overview of the creation and development of the Comprehensive Rural Health
Project in Jamkhed, India. They work in the poorest villages in their area.
The communities select women to be trained as Village Health Workers. The
women come from all castes, but during the initial two week training and
weekly one-day on-going training, caste became less important. They talk
about personal worth and self-esteem. The women are all volunteers. They
are treated equally and taught that everybody is equal. There is a team approach
to everything, no hierarchy. The VHW is seen as an important person because
they represent their village; this has raised their self-esteem. Change happens
in quiet ways, not by confrontation or revolution. The project doesn't evangelize
and yet the women ask for a bible study every week, and many have expressed
how they have come to know Christ. What is the sign of an effective PHC program?
No cases of diarrhea, pneumonia, or malnutrition in the hospital because
it is taken care of in the village. It is a dynamic program that changes
as the health needs of the population changes.
