 All right. Good morning. Sorry for the few minutes delay in getting started. My name is Talia Dubovie. I'm the deputy director of the Global Health Policy Center here at CSIS. It is my pleasure to welcome you this morning to what promises to be an engaging conversation marking the Lancet's publication of a new series on health-based, faith-based health care. Before we get started, I want to thank Shepard and Anita Smith for all of their work on this morning's event. I also want to say thank you to Katie Peck and Jillian Locke on my team who are instrumental in pulling everything together this morning. Faith is a powerful force in the lives of individuals and communities throughout the world. Faith-based organizations are an important provider of health care globally, and they are a resource for improving access to health services and support, particularly at the community level and for hard-to-reach populations in some of the poorest places in the world. As Rick Warren of Saddleback Church has noted, there may not be a health facility in every town, village, and hamlet throughout the world, but there usually is a church or a mosque or another place of worship. Engaging and leveraging the reach of faith leaders can be critical to meeting global health and development goals. The nexus between faith and health and the potential for better cooperation and new partnerships is an important topic for us here at CSIS. We've explored these issues through a variety of lenses, including active collaboration with the faith community around the AIDS 2012 conference here in D.C., as well as through Janet Fleishman's work looking at opportunities for faith leaders to play a role in promoting knowledge of and access to family planning and reproductive health services. These issues will continue to be a focus of our work. As we celebrate the role, faith-based health care can play in the global health arena. We must also acknowledge the challenges and disagreements that are sometimes associated with the faith community's role, notably in discouraging or opposing the use of basic health services, including family planning and immunization, as well as controversies in places like Uganda, where discrimination against the LGBT community endangered people living with HIV. Moving forward, it will be critical to find ways to engage productively on these sensitive issues. It is also essential to better understand the role and contributions of faith-based providers and to improve coordination between the faith and health communities. We will hear more about all of these important topics from our panelists today. I will now turn the microphone over to Bill Summerskill, senior executive editor at the Lancet, who will introduce our first panel. Thank you and good morning. On behalf of the authors, I'm delighted to introduce this session about the Lancet series on faith-based health care. This was made possible by sponsorship from Capital to Good. In addition to the booklets that you've received, additional material is available online for free and the full contents will be published in the weekly edition of the Lancet next month. Faith-based organizations deliver a substantial amount of health care around the world. How much and to what benefit has not been well documented? In preparation for the sustainable development goals in which collaboration between different sectors will be crucial, this series sets out to estimate the contribution of faith-based organizations to health care. The particular strengths and weaknesses of faith-based actors and how their expertise might be best recruited in the future. By doing so, the authors have initiated a respectful science-based dialogue about faith-inspired behaviors to which we welcome the input of CSIS. The three panelists here were each lead authors on one of the three review papers in the series. Going from your left to right, Jill Olivier has worked with the World Bank and is now senior lecturer and research coordinator at the University of Cape Town. She is also director of the International Religious Health Assets program. Jill combines these skills as the lead author of paper one, understanding roles of faith-based health care providers in Africa. Andrew Tompkins is emeritus professor of international child health at University College London. He combines a distinguished academic career with extensive experience in the field to present a sensitive review about the influence of religious beliefs on behavior in the second paper, controversies in faith and health. The final review towards stronger partnerships between public sector and faith-grade groups for improved health was not intended as such, but rather planned as a brief viewpoint. However, peer reviewers were so enthusiastic that the authors were asked to expand the manuscript into a full-length review. Leading that effort was Jean Duff, head of the partnership for faith and development and coordinator of the joint learning initiative on faith and local communities. And at your far right, Anita Smith will moderate today's session. She is president of the Children's AIDS Fund and a past co-chair of the President's Advisory Council on HIV AIDS. Ladies and gentlemen, the panel. Thank you. Thank you so much to CSIS for hosting this important event and to Bill for the introduction. I did want to ask Bill one question if I could before we start with the panelists. I don't, you probably would need to get back to the microphone. But this entire series would not be possible without all of your support. And I just wanted to hear from you as we start this discussion what your goals are in terms of how you want to see the material that's being published, used, and how you'd like to see outcomes based on what you're supporting through this effort. Thank you, Anita. The founder of the Lancet in 1823 set out with two purposes. To inform and to reform. And so the name Lancet means both a surgical instrument and a narrow window. And Thomas Whackley said I want to use it for both these purposes. To cut out bad practice and to shine light on good practice. And I think that still directs the way we approach topics. And health is such a vast part of our lives with so many different interfaces that this is a really large area of health which has received disproportionate attention over the years. It's a very sensitive area and I think that may have made it difficult for groups to explore it in the past. And I think it's also a very vast area with a heterogeneous evidence base. So it's difficult to make firm conclusions in the way one might do for other aspects of health care. So with this issue, what we want to do, however imperfect, is to set down a marker. And to say this is an important topic, it's going to actually be more important in the future and if we are to achieve the sustainable development goals, we need the help of all potential actors. What I'm hoping is that this initiates a dialogue which is then taken up by other science, sociology, health journals, that we move the influence of faith-based provision of health care from the margins of the debate and make it mainstream. So my metric of success would be for people to write in three, four, five years' time. This was great, but it's so terribly out of date this issue. I'd like to see things move on. And as they do move on, I hope that the Lancet can be part of that. Thank you so much for that perspective, which gives us a perfect foundation for the presenters this morning. Thank you. Good morning, everybody. I'm going to crane my neck a little bit because I do have a few slides. This paper that I'm presenting on behalf of my co-authors, for those of you that are not familiar with the area at the intersection between religion and public health and development, it's a very diverse area with major evidence holes. I don't even say gaps. They are big black holes where we simply did not know things like how many faith-based providers, services there are. What is the influences of faith on individual health behaviors? So what this paper sought to do was to provide a synthesis based on a series of systematic reviews on which the authors were a part, a synthesis of primary research in which there was some substantial evidence that could actually be committed to. So what the focus ended up being on was on African faith-based health service providers. We were presenting this at the bank, and I thought I put this quote up there, but there's been a lot of these kinds of quotes that have been floating around for the last 20 years. This idea that there's a substantial provision of health service provision in Africa by these faith-based health providers, but the sense that we don't really know the numbers. We don't really know what's going on. These kinds of quotes have been around for a long time, but I think I would argue that we do know a little bit more now in the recent time. So what this paper is focusing on is specifically on that cluster of countries in Africa, where there is a particular presence of faith-based biomedical health service providers. So we're not looking at traditional healing practices here. We're not looking at faith healing. We're not looking at a variety of other important issues. This is really looking at the hospitals, the clinics or family health care centers in those regions. The evidence base is biased towards Africa, towards Christianity, and towards English literature. I'm saying that now. We did not know enough about the Islamic facilities and other facilities. We did not know about the northern Africa cell health regions, but there is some evidence in relation to those countries. This is a very common slide. The first column provides the national faith-based health networks self-declare on the percentage of health service providers against the public service provider. So for example, they normally count it on number of hospital beds or number of facilities, and they would compare the faith-based Christian, normally the Christian faith-based health services against the government facilities. And as I just point out, these figures are highly contentious. I wouldn't like to get a quotation in the New York or whatever Washington News saying I've quoted these. What the paper tries to unpack is the fact that these figures are very contentious. And what we actually argue is that there's a need to move away from this focus on percentages of market share. The argument is really is that basing your entire engagement on the faith sector on the idea of whether or not they provide 20 or 25 or 30% of the health services is actually less important than the issues such as do they provide quality health care to the rural poor? Do they emphasize universal health coverage to people that don't otherwise get access? Do they provide a different kind of care that supports the system and makes the general national health system more resilient? And so really the argument is to say moving away from those kinds of figures of market share and trying to look at things such as utilization, cost satisfaction. And so we're pulling on data in this paper. We're trying to pull on what data there is on these other aspects which we consider to be more important. I'll just touch on a couple of issues. We presented some household survey data which was looking at utilization, which did show some slightly lower market share than we had originally assumed. However, it's comparing apples and oranges to the bed-based kind of comparison, so don't worry about that too much. But we did find quite a lot of evidence to the fact that in those countries a lot of patients were reporting on higher satisfaction levels. And those higher satisfaction levels were normally based on the idea that they were getting a higher quality of service in the faith-based versus the public facilities. There was also some evidence to show that faith-based health service provision is particularly important in weak health systems. And that's not just in Africa, but that's internationally. And weak health systems is not just normally weak health systems, but also in times of humanitarian crisis, in emergency response. That is when faith-based health services jump in. I'm not going to go through this whole slide, but just to say that as I mentioned earlier, there's a push away from broad generalizations about faith-based health service providers. I would encourage you very strongly not to use the word FBO just generically. They're all kinds of FBOs and FB things. And so really, so being specific in the evidence, being specific in the engagement, and being specific in the implementation strategies is really important. And I'm going to stop there. Thank you very much. So we'll go ahead and have all the presentations and then open for questions. So, Andrew? Well, we had a very interesting and challenging task of looking at the controversies. And as you would imagine from the title, we had a rich diversity of people to inquire and include in the team. And I think the key thing we wanted to emphasize in the paper was that there are many, many people who report faith in the world. In fact, the Pew Forum actually says that in their surveys more than 84% of the world's population report having a faith. So this slide just shows some of the major faiths. And our methodology involved looking at differences between faiths and sometimes differences within faiths. And that is a very important thing to do. The second slide, I think, just shows the importance of not being too simplistic in attributing anything to faith belief alone. This slide just emphasizes that in the center we're talking about things like attitudes and beliefs and prejudices and behavior and choice of technologies or the things that we think of every day. But it isn't just faith that actually influences. Sometimes it's actually centuries and thousands of years of culture. Sometimes it's social and economic aspects. Sometimes it's issues in relation to the laws in the country which may actually conflict with faith. And obviously, there are very important political dimensions. And unfortunately, sometimes beliefs and behaviors are affected by extremist ideological positions. When we looked at various components, we looked, as you will see in the paper, at a series of health damaging behaviors, which included childhood marriage, opposition to immunization, violence against women, and female genital mutilation. And we looked at the way that faiths actually had a viewpoint on this. And then we looked at how, notwithstanding the considerable varieties, there was often a commonality. And we gave a lot of examples in the paper of ways in which groups, sometimes with different faith backgrounds, have come to work together for the reduction of child marriage, for the increase in uptake of immunization, for the improvement of care for women, for the reduction of stigma, and improvement in the provision and care in HIV AIDS. So those were some of the things that we looked at. And this slide just shows a bit of a problem. What we found was that within the faith leadership group, there was often a limited awareness of what was going on in the world. And we actually found that there was a considerable problem in faith leaders remaining within their intellectual and theological faith faculties. At the same time, we found that those working in some development agencies, and some working in some development agencies, were actually extremely unaware of what faith actually meant. And therefore, there was a tendency, particularly for those affected by intense secular agendas, to stay within their secular silos. So we had faith faculties and secular silos. Now, this may be a bit of a parody. And I do apologize to those of you who object to this. But we actually specifically raised it. But because we saw at the bottom some remarkable opportunities of faith groups, probably using the word that actually I've just been told not to use, but faith groups, working intensively with governments and local communities. And we provide within the paper some great examples of that. What are our recommendations? Well, we would like to see that the health care leaders become more faith active, and the faith leaders become more health active. I'm not suggesting that all faith leaders join gyms or health leaders go to the mosque. But it's obviously important that literacy and understanding are improved. Notwithstanding these issues, we do provide some evidence. And there's quite a lot of peer-reviewed evidence showing that there is remarkable opportunity for faith to be integrated within programs. And we can actually see that already there are opportunities for imaginative programming. So what do we seek to achieve from this paper? We would hope discussion, possibly disagreement. But we see actually quite likely to be an opportunity for groups to work together for the improvement of care. And what our real goal is to move from controversies into compassionate, professional, patient-sensitive, faith-sensitive care, especially for the hard to reach. And we do not believe that the goals of sustainable development will be achieved unless some of the issues that we raise in our paper are taken into action. Thank you. Thank you. Next one. There we go. Thank you so much, Anita. Good job on my side. Good morning, everyone. Thanks to CSIS and to Shepard and Anita for helping to organize this session. Thank you, Bill and the Lancet. Thank you, my fellow authors and the working group of amazing people who collaborated over a sustained period of time to bring this unprecedented series on faith-based healthcare to launch at a conference on religion and sustainable development, which was held over the last several days at the World Bank. Kay Warren was a key inspiration to this series, informed by her deep, lived out experience, personal experience of how religious and faith-based organizations transform stigma and save lives of people living with HIV-AIDS. Our paper focuses, picks up really, where Andrew just left off. It focuses on the question of partnership between public sector organizations, between governments and donors, and faith groups in general, and the question of what exists by way of partnership and what might scale up and strengthen partnerships. The paper lays out a case that the time is now right in the context of development trends and opportunities to very substantially increase engagement with faith-based organizations. It basically posits the notion that policy and policymakers seems to be moving beyond the question now of whether to engage, but how to collaborate. The paper offers a couple of signs, including the recent meeting between President Kim at the World Bank and the Holy Father, where they discussed their mutual approach to implementing a preferential option for the poor. At our conference over the last couple of days, a notion that was tagged in the paper of public sector organizations themselves becoming more activist around these issues was underscored by the very activist participation of the German government, who have newly constituted a focus within their development agency on this work. On the faith side, groups... Next slide, please, sorry. Great, thank you. Next slide. On the faith side, the paper reviews how existing partnerships and mechanisms are expanding collaboration. And we look at those in three groups. We look at large-scale interventions, such as the Australian government's extraordinary 10-year investment in Papua New Guinea, where they work through the congregational networks of seven denominations to provide services to the very poor there. We look at public co-funding for faith-based hospital and primary care through national networks, such as the church's health associations throughout Africa. And thirdly, we look at global health campaigns where faith groups are involved, such as the United Methodist's Imagine No Malaria campaign, which to date has raised over $66 million, and is a significant donor to the global fund in Papua New Guinea and malaria. So a very interesting partnership there between a faith body and a multilateral donor organization. The paper also references the long-standing ongoing efforts at key UN agencies to facilitate partnerships. I would like to just note, in terms of the co-funding, the important leveraging by public sector of substantial private assets that the faith community brings to the work of development. I would like to tag for your further reading a study of the revenues of U.S. faith-based NGOs, which in 2013 amounted to over $6 billion, of which public funding represented only a small proportion. I think it was $777 million, so a small share. Next slide, please. The paper drills down on the case for partnership by looking more specifically at contributions to the prevention of maternal and child deaths and unpacks the every woman, every child framing by UNICEF that looks at the accelerator behaviors that are key to determining health outcomes for women and children and makes the point in a systematic way that faith communities are very well positioned to influence those key health-related attitudes and behaviors, such as breastfeeding, immunization, access to care that make a difference to those health outcomes. We offer a variety of interesting case studies and examples from Nigeria, from Mozambique, from Sierra Leone and DRC and elsewhere, and I commend them to your more detailed attention. Finally, the paper drills down on a series of recommendations for strengthening partnerships, and those recommendations are clustered in five areas, and again, time doesn't permit us to go into them, but we offer them for your further consideration. They include a suggestion of new business models, in a sense, ways in which both the development communities and the faith groups can reorganize themselves to be more effective in partnership mechanisms. It was interesting that when this paper was conceived almost 18 months ago, the conference that took place over the last couple of days was not even intended, but it was absolutely fascinating, I think, for all of us, to see how the work embodied in the Lancet paper was very much a grounding for the conference over the last couple of days, and these recommendations that you see here were elaborated very extensively in the work of the conference, which looked at ways to strengthen partnerships between public sector and faith-based organizations. Thank you so much. Thank you, Jean. Well, based on these presentations, this is just a taste of what is in the document that you have that you will definitely want to read if you aren't already into it. Thank you all for your excellent presentations. Just wanted to... Well, you're preparing your questions in the audience. Let me just ask each of you a question. Jill, I wanted to clarify that the faith hospitals that you were looking at, were you looking at clinics or were just hospitals? How extensive was the data? The data was looking at all levels of health facilities down to primary care level. But again, there are data holes all over the place, but most of those ones that were shown there are Christian health associations, and they normally map the whole number of facilities down to primary care level. Okay, and I mean, there obviously is a lot of work to be still done to get beyond just the Christian facilities. Is there work underway that you're aware of? There's work underway, but it is also... I just wanted to stress there's a lot of complexity as well. There are a lot of, for example, health facilities, faith-based facilities that are owned by the church but that operate as a public district hospital, for example. So it's not quite as black-and-white and care-cut, but yes, there is work underway in a number of countries worldwide. And how many of those facilities would be kind of a partnership between government and... It differs per country. They call them district-designate hospitals, and there's probably 20 or so big hospitals. They're normally in areas where there is not a substantial presence of the public system yet, so... Okay, great, thank you. Andrew, what an interesting paper and look at the controversies. How did you and your team go about deciding what you were going to look at and how did the team work together to come up with the outcomes in the paper? Yeah, with fear, trepidation, energy, enthusiasm, and an objectivity. I'm just giving those on the top of my head. Basically, as scientists, we are basically looking at what is the evidence, and we didn't have any particular acts to grind. And as the readers of the paper will see, there were representatives looking at all the major faiths in the issues. We came particularly from the perspective of what are the particular needs for hard-to-reach populations of particularly women and children in poor communities, unreached communities in poor countries. That was really why we looked at some of the key risk factors for poor mortality rates, for poor nutrition rates, and poor development of children and adults. How we did it, we basically looked at the problems and we analyzed them using traditional sacred texts, and we also looked at the ways those texts have been interpreted in different ways. And then we moved on to see how the texts have actually inspired and driven health workers to provide services in very difficult situations. Jean, congratulations on already putting some legs to this effort through the conference. I know it was a very successful event. I think one of the questions that people have is why have these partnerships been so difficult to bring about, and why has it taken this long to come to this place? Thanks, Anita. The event that Anita is referring to is this conference on religion and sustainable development. Effective partnerships to end extreme poverty, which was held over the last couple of days at the World Bank and co-hosted by the US government, I'm looking at Mark Brinkmuller here in the front row, the German government, the British government, World Vision, and other leading faith-based organizations. And in itself, I think it represents part of the answer to the question. An extraordinary collaboration among governments, faith-based organizations, and the academic community around these issues. Anita, I think that part of what we struggle with is a cultural divide. We have different methods and different approaches. We definitely have a common ground, and certainly as framed now by the coming sustainable development goals and this commitment to end extreme poverty, we have very clearly common grounds, but we have different approaches. And I think what's so heartening about the discussions over the last couple of days was the spirit of collaboration, the reciprocal frame. Yes, a call for, on the part of the public sector organizations, for a very strong evidence grounding and really a challenge to the faith community to step up just the kinds of evidence that Jill and her team, for example, have been presenting. As a basis for discussion. But I think that our work, the work ahead, continues to be the building of trust, the building of understanding, the building of what we call faith literacy and development literacy across the two communities. And I would like to just point out that the materials, all the materials for the conference are available on the website of the joint learning initiative at www.JLIFLC.com. And I commend those to you. Great. Great. Thank you. Well, now we'll open the floor to questions. There'll be people coming by with microphones and so please wait to get the microphone before you ask your question. I'd like you to identify yourself and your organization before you ask the question. We'll take three at a time and then we'll pose them to the panel. Okay, we've got several hands up here. Good morning, ladies and gentlemen. Thank you so much for your presentation. My name is Rosemary Seguero. I'm an organization called Hope for Tomorrow, a U.S. best organization, though we are also best in Kenya. Thank you so much for your presentation. I just wanted to mention about what you said on, there has not been a partnership, collaboration, outreach and awareness through partnership with civil society, government and other people. So how do we make this happen? Like HIV failed because of lack of coordination, collaboration like a Mahia civil society. What we are talking here in Africa I don't know what we are talking about. So this message is very, very important to faith based all over the world because without this message reaching them there can't be any implementation. So how do we work with you guys? We just came up with applications of communication where people in Africa can hear what we are talking now using healthcare, education and everything. So how do we collaborate instead of just hearing of the report instead of actual implementation and results of what you are talking? Thank you. Hi, my name is Katie Lutens and I'm the health program coordinator at the corporate council on Africa, which is an association of businesses interested in Africa. I was, this question is mostly I think for Andrew. Did you find big differences between religions, particularly religions that do not have sacred texts or that are not, don't have one overarching philosophy for the entire religion? Like folk, you know, Vodun folk based religions. Thank you. My name is Michael as a former retired World Bank staff. I have worked in many countries in Sub-Saharan Africa and for more than 35 years. And a lot of what is discussed here is timid in the sense that I expected your team to look at the relationship between faith-based health services and government policy development. The relationship between funding agencies and faith-based institutions in countries. I give examples to give a little clarity to my question. When I worked for the World Bank and went on missions to countries, my colleagues were very reluctant for us to spend time discussing either the Baptists or the Catholics or the Presbyterian institutions. They were very unprepared to integrate statistical data from these facilities. I remember the case of the DRC where at one time the Catholic church was doing a lot more than the government was doing. But this was never really integrated in the analysis for policy reforms or for program development or for program evaluation. When I myself worked for the Cameroon government before I joined the World Bank, I helped and developed a relationship between the missionaries and the government, especially in the area of medical statistics. And the most complete statistics we were collecting were from the Reverend sisters, the nuns and so on and so forth, not from the government. I worked on other countries where when you visit a health center in an urban environment that is missionary run or faith-based run, attendance is probably four times the size of a more equipped, more staffed public health institution in the same town. There are several African countries where the referral hospital in the country is not in the capital city. It is in some remote little town managed either by the Catholics or by the Baptists. And so there's been a conflict in relationship. I hate to see us move ahead as if things have been very sweet and nice between government policymakers and development institutions because it has not been the case. In fact, in some countries, the missionaries started training health personnel, but the governments got discouraged from supporting the programs because of World Bank IMF institutions discouraging the use of public funds in what was classified as private enterprises. And that has cost us a lot. Thank you for your observation. Let's take one more question and then we'll go to the panel. My name is John Blevins. I'm director of the Interfaith Health Program at Emory University in the Rollins School of Public Health. My question is mainly to Dr. Tompkins, but I wonder if others have thoughts on it as well. In regard to reaching hard to reach and vulnerable populations, particularly in activities and programs that might be of a contentious nature in cultural context, a lot of faith-based organizations that we're aware of that do that work, that work arises intrinsically around a complicated but potentially contentious negotiation between the faith-based providers that do that work and their larger religious traditions. One of our concerns is that when actors from civil society or the multilateral or bilateral donors are made aware of those programs, how does it change the impact and the effect of those programs in ways that may be negative? That it makes them and the staff in those organizations more suspect or the work of those organizations suspect or maybe even puts those staff members and the people who receive services in danger? And I wonder if you saw any evidence of that and if you have any thoughts about ways that civil society organizations and the large donors can be aware of how to build respectful partnerships with those organizations and how to reach in vulnerable communities. Thank you. Yeah, some great questions. Thank you so much. If I could start with the core which is coming out of nearly all of the questions about collaboration. If we look at the political framework in which my comments are based, it is that sustainable development goals are going to talk about universal health coverage. It's a challenge, but it's important. It's vital if we are to reduce poverty. The bank has changed its mind. It used to be saying you can only become healthy once you become rich. Now we're saying, and I know this is true, that the bank is saying that you have to be healthy to increase your standard of living. So the question, several things. Part of them are comments that have come out of our review in the paper and my authorship team and partly are some comments because I've lived in Africa for many years and have been privileged to do so. The first thing is that when the faith groups are involved in health care delivery, it seems to me that often there is a tokenism rather than a true involvement. And one of the challenges seems to be the coming out of this, that the governments and the agencies actually need to lose the nervousness that you, sir, described, the anxiety and just get real and say if we want to achieve health coverage, then we have to look at ways of working together with partners who are working in the poorest. Now that actually means that literacy as Jean was saying, needs to be developed. And there are some good examples in the paper of ways in which faith leaders have actually been the leadership of the programs, particularly in some of the health damaging practices. And more recently, our experience in northeastern Nigeria is that the faith leaders are absolutely vital in assisting the increase in development of immunization services which have tragically declined over the last few years. You mentioned, ma'am, about Kenya and you give a good example of countries where there are great opportunities for people in government and the donors and the people who work at delivering health care to actually understand each other's language. And I think there needs to be a greater appreciation, a knowledge and respect. And at the moment, I sometimes be quite blunt, have found lacking in international development agencies. They do not want to accept that there are people who they disagree with in their own personal lives. So I think the challenge is how do we get people to move out of their personal prejudices and work into global care, which is what we're talking about. Just a sort of a short answer. Thank you. Maybe if you'd like to comment. Sorry, I didn't catch your name. The gentleman from the bank. Mike, thank you. I think there's been a bit of a change since the era that you're talking about. I've been involved in this work for a long time, for a long time, like a number of friends and colleagues have been as well. And in the beginning, even 15, 20 years ago, every time we started a meeting or every time we started writing something, the first sentence would have to make an argument for the relevance of even looking at this. It would have to make a statement about the relevance of even thinking about the collaboration with the fair community. That's where those market share figures started coming out of was because that was one piece of evidence that people were using for that statement. But things have changed quite a bit. There is work and published work on statistics on contracting. The WHO has sponsored work right now on the contracting relationship and the financial compensation relationship in three African countries, universal healthcare coverage studies. I'm not saying the relationships are not fraught, and I'm not saying that there is constant work to try and build the trust between the faith-based providers and the governments. It's an ongoing... Well, all partnerships have dynamics. But I don't think it's quite the same as this kind of... No, we're not even going to think about it. I think there has been a change. There are lingering biases, secular biases, which many of you in D.C. will be very familiar with, and us as authors are very, very familiar with. And I think that was part of the... what Bill was alluding to about saying how this is an unusual area of engagement for the Lancet because of those biases. But I think there's a... At an international level, I think there's a slight... a slight more openness to thinking about this and engaging this and considering those issues. And I just wanted to... I think this year by Kenya and engagement, I think underlying your question was this, you know, why I have the meeting in D.C. and talk about these things here rather than in the countries. All I can say is these conversations and these collaborative partnerships are absolutely happening on the ground in countries. Several partners here, USAID, PEPFAR, John Blevins from Emory, I know they're doing lots of work on collaboration and networking in Kenya with local partners. And so I think it's not just here in D.C. that these conversations are happening, if that was the subtext to your comment. Just to support what my fellow authors are saying here and going to our sister from Kenya's question around the challenges of partnership, what I'm so excited about is that there seems to be a real movement both on the policy side and on the faith side to look at evidence-based developments and new approaches to forging those partnerships. I see Deb Derrick in the audience there from Friends of the Global Fight on HIV, AIDS, TB. Organizations like the Global Fund, for example, are working now very, very intentionally on the challenge of how to engage more effectively and more inclusively local faith communities and faith-based partners in country. And indeed, I was so heartened during our conference to hear Christopher Ben from the Global Fund saying that during the Ebola situation in West Africa, that they directed their grantees to basically repurpose funds that had been assigned for HIV or TB to Ebola. I thought that was a wonderful example of sort of the institutional flexibility, obviously, in a crisis, but a really, really good example of that. Going to Jill's point in terms of contracting and new innovative financing mechanisms and contracting, Kamarogo from your country from Kenya spoke to us at the conference yesterday and actually challenged faith-based healthcare delivery systems to formalize and to strengthen their contracting mechanisms. And in fact, he kind of challenged them to say that those MOUs that you have are not worth the paper that they're written on and they're really pushing people towards more formal contracting. And then on the faith side, I think it's really up to us to step up and to offer more robust, collective organizations that bring us together in larger scale so that we can deal as collective bodies, not necessarily just small institutions with governments so that they can achieve their scalable objectives in terms of development. Those are some thoughts. Thank you. And, Andrew, there was one more question for you on the differences between religions that you made yourself. Yes, that was an interesting question. You asked about were there any differences between those who had a written theology as opposed to a more verbal? What was that? Yeah. The main faiths that we looked at obviously did have a written... What we didn't look at was and we've actually referred to this in the paper was the enormous richness of traditional faiths. Certainly I can speak mainly in Africa, but I mean I'm sure the truth is in Asia where these faiths have been there for years and are sometimes in a syncretistic way actually sort of combined with 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 interesting thing is that there was a considerable enthusiasm among all 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, their 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's 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 from the panel. Any other questions? Okay. Well, I will ask each of you on the panel. You've done such an amazing work and have given us so much to think about. I would like to hear from you in summary what you would like to see as next steps as a result of your work that you've put so much effort into the research and the writing and not necessarily related to the piece you've written but how you'd like to see this play out. Jill? Our answer is an academic and someone immersed in information and evidence. That's where my head is at the moment. It's very similar to the comment about the Lancet by having these papers in here signaling something in terms of the broader discipline. I'll give you an example. There was a conference on the Health Systems Global Conference last year in Cape Town, 4,000 people there. I think there were two presentations that had anything to do with faith-based health providers of a big, massive, multi-thousands of people at this conference. That's a signal to the fact that these issues come up in conferences. We have separate conversations about issues of faith and faith-based health providers but they very rarely are integrated into the broader public health development agendas and conversations. My hope would be that rather than this becoming a standalone conversation gets more strongly integrated into the broader public health and development conversations. 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. The markers should be gained at donors and health providers in terms of how aware are you? How much are you being inclusive? Many have been exclusive. We've got some wonderful examples that Jill's talking about that are in the paper. We've got an inclusive argue of faith groups within your policies and your programs and it will be possible to look at policy and to look at the international development agencies and to see how well they're coping with the challenges that this paper puts forward. Similarly, I would see that the faith groups 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, I don't think they've ever been subject to peer review and monitoring and evaluation but the peer review process would be a very interesting one with the faith leaders, the theological colleges all the colleges that are churning out faith leaders. It would be very interesting to see if they could become more faith aware because that does have enormous potential for changing the societies which are hurting at the present time. One of our presenters at the conference yesterday, David Sutherland who's working in the Philippines with an organization called International Care Ministry challenged the conference with the notion of how do you measure hope and dignity. I think that our challenge now, our real opportunity now is to build on the growing interest by virtue of the scale of the ambition of the goals, the development goals, the growing interest on the part of policymakers for engaging all hands in the development task and therefore also being very open I think to engaging 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 health outcomes and I think that we need to do that in creative ways. A lot of the 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 those cultural divides that we addressed earlier in the remarks in the paper. Thank you. Thank you all. And again, thank you to the Lancet bill for publishing this important series and opening the discussion which will go on. Thank you very much. We're now going to move very quickly to our second panel which is going to look specifically at what all of this means for US policy. For those of you who are standing in the back there's a bunch of empty seats up here in the front please feel free to come on down and take a seat before this next panel gets started. Thanks. We'll need you to turn on your mic. Thank you all. In the interest of time we're going to dive right into the second panel which is going to give us an opportunity to look at the US angle and the US engagement with 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 Coordinator and many of you know Sandy from her long work in this arena. We, too, in the middle we have Mark Brinkmuller who is the Director of the Center for Faith-Based and Community Initiatives at USAID and on the far end we have Jen Cates who is the Vice President and Director of Global Health and HIV Policy at the Kaiser Family Foundation. You have their full bios in the handout so I won't go into all the details but you can see that we have a very very 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 and providing information especially in reaching communities the poorest of the poor, hard to reach areas. I'm reminded of a time not long ago when I was in Ethiopia and interviewing 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 isn't a sin hungry children is a sin and it's just a fascinating lens through which we can see again the importance of faith leaders and the information they can transfer to their communities and the importance of engaging them in ensuring that they have the information and the capacity that's 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's true what the first panel really emphasized that things are evolving, things are developing and this is an important moment to be exploring this further and with this panel we're very eager to talk about it from the focus of the US policy perspective and I think to begin with we will turn to Sandy Thurman given your long involvement with HIV policy from the US government can you describe to us a little bit more about how PEPFAR first began partnering with faith organizations and how that has evolved. Thank you and thank you all for being here you know it's interesting the faith community has been a partner in our response to HIV since the very beginning of the epidemic both domestically and globally and so I think that our partnership in PEPFAR was an outgrowth of our experience in partnerships 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 of our interest and a lot of the pressure that was brought to bear on the US government and policy makers was from faith-based organizations who were on the ground in Africa seeing the devastation that was occurring on the continent so they've been a natural partner for us faith-based organizations and faith actors have been a natural partner with those of us working in the HIV and AIDS response from the beginning and so when we began to expand the global program to focus on HIV internationally and I want to sort of 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 was of course a rounding error in our PEPFAR program so we saw when the interest started faith-based organizations were at the forefront of encouraging us to really respond in a very robust way and that of course ultimately led to the development of PEPFAR we just add though that our faith-based partnerships were not based on politics they were based on pragmatism that when we looked at the people who were on the ground who had access who had trust in the communities all the things that we knew we needed and partners to move quickly in PEPFAR they were a primary and natural partner for us It's so interesting how all this has evolved and we'll get into more of some of the spectrum of groups and the challenges and opportunities that that has presented but that leads in perhaps for Mark to tell us a little bit more about your office at USAID what are the goals, what is your outreach what is your strategy so I have the great privilege to head this office at USAID that has its origins back around 2003 under the Bush administration and trying to do a more systemic and engagement with the faith community that said USAID has been working with faith groups since the inception of the agency 52 odd years ago and so this wasn't in one way new to the agency there was a new emphasis and a new way of looking at it and to reach out to a broader group of partners I would say and it continues to be a guiding star for the agency but if you think about buckets of work certainly to be the ombudsman into the agency the Sherpa to carry groups that want to work with USAID and don't know quite how to get in the door of the bureaucracy can come through us to do that groups act a little bit like an ombudsman when there are problems we can help facilitate finding solutions to problems for faith-based and community groups we also try to do proactive outreach so to convene around Ebola as a recent example we organized with the White House and 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 what the role of the faith-based community might play we did smaller groupings of that in DC as well we had 30 or 40 organizations so there's a convening role of the organization and there's a role of supporting the other parts of USAID that are trying to get things done so we support the missions and their engagement and that's a critical part of the ID for a big government agency we're very decentralized our missions in individual countries are vital and really decision-making happens much there and so those are all the ways that we try to put it in and so we try to make our engagement with the faith community as robust as possible especially when there's 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 US government support goes through faith-based organizations and so many of us turned to Kaiser for that kind of analysis and I wonder Jen if you could tell us a little bit more about how that, how much Kaiser has approached that and why that's a complicated set of numbers to find Right, 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 or really pick up and formalize an evidence-based framework which is so critical that I don't think has existed at this level ever for looking at the intersection of faith-based organizations and health and so for this question which is one that we always ask at Kaiser what do we know, what's the scope of the involvement and Mark and I were talking in advance of this and clearly money is just one measure of this and there's many more ways to look at involvement but 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 but there's also some really good work that's being done now on this IHME and the researchers at Chris Murray shop I think with Jean Duff looked recently at development assistance for health and there's an article that just came out a couple weeks ago on this roughly estimating that over the last decade or more about 30% of all development assistance for health has been channeled through faith-based organizations and that's a complex analysis there's a lot there but I encourage people to look at that article it was in Plusmag Journal so that's available online the other piece of work that's been done is Jean's work looking specifically at the share of revenues that faith-based organizations have that are from US government sources and she actually found it was about 13% so it's I think less than people think in their minds so in preparation for this panel I took a look at some data we recently released around non-governmental organizations another broad area that faith-based groups fit into that we don't know enough about so what's the role of NGOs in US government global health we put out a couple reports on this we're putting out a summary analysis soon so what we tried to do is say well what do we know about faith-based organizations within that framework what we looked at was 2013 data that's 2014 just as available now but 2013 data disbursements by USA so there's all kinds of caveats there but looking just at that year we were able to identify that faith-based organizations represented about 15% of NGOs that received a disbursement on global health from USA in 2013 so 15% of the NGOs were faith-based and just about 4% of the funding went to them and I think it's less than people think and it would be good to look at historical analysis and see maybe how that has changed we also found that faith-based organizations within the NGO community were more likely to be working in Africa than NGOs overall not a surprise probably to those of us here but an important data point and the area that they were most likely to be working in again not a surprise HIV malaria was also a big one and malaria and HIV probably more so than NGOs overall less so in family planning so those were some of the findings that we looked at we'd like to look more in depth but just to give you a sense so more likely to be in Africa HIV and malaria were two big areas and probably less funding than people think I will just to give you the funding amount because I think people I can see people wondering what that amount is it was about 96 million in 2013 for what to give you a sense that's less actually than the global fund amount identified in the IHME analysis Thank you we're just going to run through a series of questions and then come back and give you a chance to interact with each other perhaps link to this the question of who are these what are these organizations where are they working what are they working on Sandy you've described from your long years of work the spectrum of kinds of organizations which helps underscore the opportunities and the challenges of working with them perhaps you could talk a little bit more about what you mean when you talk about different approaches needed for different kinds of faith based organizations sure thank you I think this is a genesis of some of the challenges we've had around building these partnerships between faith based organizations and governments because it's hard 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 I think is still and I'm just using the US as an example is still the second largest healthcare system in the country to very small clinics or NGOs or orphans and vulnerable children's programs on the ground so there's this incredible broad range very big differences in capacity very big differences in ability to deliver services and so I think our challenge to both donors and faith based organizations is to begin to define with greater specificity and communicate what those differences are for people and it certainly came up a lot in the meeting that was 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've 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 mechanisms and so forth that we have to just be very clear about what we're dealing with and that it could 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 of health that if we want to really look at sustainable change at the end of the day and we want to be able to have countries take full responsibility and ownership of the work that's being done in their countries that that has to be rooted on the ground in grassroots organizations all over the country so if we want to sustain the impact that we've had in PEPFAR or we want to look at sustainable development we need to figure this out so we need to just stay at it until we do and it won't be easy it's like family dynamics they're not easy but it doesn't mean you abandon the family you stay in there and you work at it and I think that's where we are and this conversation is very exciting well it's 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 from 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 so I think there's two elements of this one is that faith based organizations like most non-governmental organizations have robust fundraising largely from the private sector and have partnerships via their boards and other mechanisms in which they've been engaging the private sector since they existed they've had to do that the other is a more directive to say you know as we're looking more at the importance of the private sector in development generally healthcare in particular what are the ways we can think about the faith community those business people who are motivated by their faith but will never put a religious icon on what they do so for example there's a project that we're working on at USAID about to be finalized on health a small health experiment in a way to see if business principles can provide some sustainability and provision of healthcare clean water and others in the eastern Democratic Republic of Congo and a consortium of business leaders that are connected to 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 you know the philanthropy that flows through every year is hundreds of millions of dollars a lot of that a significant part of that will go to international activities how can we have a formalized partnerships with that kind of flow and that kind of access to capital as well as the expertise that's within that community to bring it to bear and I think that's really fertile ground to build on Jen you've done a lot of work over the years on the US response to the AIDS epidemic of course there's as we've discussed in the first panel and in the Lancet piece we saw the importance of some of the faith based organizations role 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 US response sure to pick up on something Sandy said about the role of faith based organizations in the faith community and HIV from day one that's clear in the US domestic case as well as globally I think it's really important to note that from the case study perspective of PEPFAR how did PEPFAR come to be when we all look back and try to put together what were the elements that went into many of us watching that State of the Union speech and hearing 15 billion and wondering how we were able to get there it's clear that without the faith community that would not have happened the community was from the case study perspective of PEPFAR an essential element to making PEPFAR happen so it's not just on the ground delivering services and being partners but really pushing the US government to go to another level so I think that's just really important from my perspective looking at it from the long term and I think on the Ebola response it's pretty clear that without engaging the faith community what governments had to do realizing they had to we would not have been able to turn around that crisis and hopefully the lessons from that experience will be evident and ready to pull it not just back on a shelf but the next time a crisis like this occurs whether it's Ebola again or something else you're not the forefront of this approaching communities with cultural understanding with the engaging the leaders communities that understand them and can speak to them is the only way we can really get ahead of this it's quite clear there's 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 to us a little bit about some of the hardest parts of PEPFAR's history in dealing with the faith community what lessons have been learned and how has that impacted the current PEPFAR strategy I think that it was not new with PEPFAR we've had challenges in HIV and AIDS with the faith based community challenges and incredible opportunities from the beginning but it was certainly true in PEPFAR we've had to a couple of things it's been very very hard for a mechanism as big as PEPFAR to operationalize our partnerships with faith based organizations on the ground and so that's been one and then we've had stumbles around challenges around issues of reproductive health certainly around the LGBT community we've seen a lot of those play out in recent days but it's I think where we hang on this interestingly is more Washington D.C. and our big institutions rather than on the ground what I have found always so inspiring is that the way that people who are actually on the ground doing this work figure out a way to work together and oftentimes that we have headquarters and in policy making bodies just make everybody's 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 and very hard to serve populations and the far reaches reaching places in the world people figure this out I think this is a place where we need to learn from colleagues on the ground and bring those lessons learned up to the top there's something that Dr. Blevins mentioned I think we also have to be really careful than in wanting to be so politically correct in our the way we engage as policy makers 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's secular so that they can trade and get condoms and won't get caught by the bishop in the old days we had all these wonderful stories about people just 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 we talked a lot about is finding common ground when we define with real specificity what our roles and responsibilities are when we engage in a partnership it's almost like a pre I don't know why I'm using all these marriage metaphors but it's like a prenup so we have a prenuptial agreement we know that this is what we're bringing and this is where we don't go and you can't touch this and we have to just define with greater specificity how we engage and I also think it takes the mystery out of this if you've got secular institutions and faith based institutions if you really dig down and up front and define with greater specificity you can find that common ground and not put each other at risk in any way and to be more specific we have some real controversies that have emerged particularly most recently in Uganda and I'd like to hear a little bit more from Mark about that episode putting the LGBT community at such risk the funding for the interreligious council being withdrawn by the US because of that what lessons were learned from that and what new practices or vetting procedures or new mechanisms arose from that maybe I should summarize first you know just quickly legislators within Uganda proposed an anti-homosexuality act that was draconian at best in terms of its treatment of LBGT people the discrimination of them the description of them and their own who they were as people was in so many ways beyond the pale the interreligious council and members of the religious council campaigned positively for that legislation and vocally took out ads in the paper spoke at a huge rally I was in Uganda when that rally went on and you're listening to this and thinking this is just such a horrible situation and essentially what happened I think the US government lost confidence in the interreligious council being able to carry out their mandate and serve people without bias because of it was so beyond the pale of what we normally saw in terms of active campaigning the public's nature among all the interreligious council members there were nuances between them but largely all were for it so funding was withdrawn from that institution and mechanisms were put in place to still meet the need of people in Uganda so that they weren't left without treatment in terms of lessons learned I think that situation has become polarized I come out of a community organizing background when you polarized you have to figure out how to depolarize I don't know that we've done that successfully yet how do we depolarize the other thing I think we need to do in a lesson learned is how do we learn more about what the actual discrimination is on the ground so we have the evidence that says yes this rhetoric links to a set of behaviors that are happening that are impacting people negatively we don't know that right now we make some assumptions that are reasonable but in other cases there have been legislators at the top saying some bad things but the providers on the ground continuing to do good work so we need to figure that out there was a study that USCID did in relation to PEPFAR in Jamaica about bias I think that's a model for what we want to do in other places and replicate that to see what the real actions are on the ground what are people experiencing what can we also witness certainly another area of challenge involves family planning and reproductive health and Jen I wonder if you wanted to talk a little bit about what you've seen in terms of how that has played out I actually want to just say one thing pick up our mark left off around LGBT rights and the issues that happened there is a really good new study that came out 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 actually between the rhetoric and their own fears about seeking services but I agree getting that evidence and summarizing the way that policy makers and program managers can understand is really very critical and something that goes to the family planning issue that actually I want to paraphrase something that Ambassador Burke said I think the overriding sort of issue here for policy makers is really about public health so it's really the public health approach what works for public health and as she said much more eloquently that I'm going to paraphrase that stigma in any form is not what public health and human rights is about and cannot help us be most effective in our response to HIV and that plays out in the family planning discussion but stepping back I think that the polarization 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 planning services on the ground I think that's the evidence for that is there so there's a sort of mischaracterization often of the community and it's a very 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 what women who want family planning methods should get according to public health evidence and if there are faith based organizations or other organizations who can't provide that effective service or won't it's really incumbent upon the USG to figure to look and do an assessment and say well how do we reach those who need the services the most what's the best way to do that and that's really where the emphasis needs to be from a public health perspective and meeting the goals how do we reach those who need services most and put that together I know we're going to have a lot of questions from the audience but I wonder Sandy if you could just talk to us for a minute about how does all this fit into PEPFAR 3.0 Well I think it fits just squarely into PEPFAR 3.0 and we know that 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 we have more people on treatment we've we've got to continue to move forward and we're really going to have to focus more and more as time goes on so that's very important our best partners or some of our best partners in doing that work are again going to be our faith based partners because we've got to get into communities we've got to develop those relationships of trust to get people into treatment to keep them on treatment all the things that we know that we have to do that it often takes time to do developing relationships and getting in communities and identifying people who need to be in services and getting them into treatment and keeping them into treatment and treatment we can't do that on our own so we've got to find the partners who are already in community to help us do that so expanding our partnerships with faith based organizations and again it comes down to it's very pragmatic from a public health perspective we've got to identify folks we've got to get them in treatment we've got to keep them in treatment and those programs have to be rooted in communities on the ground otherwise there's not sustainability in our work so they're a primary partner and a big piece of our work going forward and Mark you talked about exactly that issue the sort of cultural literacy I think you called it training for US government agencies to work better with FBOs to be able 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 US government have came together in the past few years and there is an interagency now strategy on global religious leader in faith community engagement part of that strategy calls for more training within our agencies across government on how to work with faith based organizations at USAID we've received money from our human capital team and talent management team basically our HR department to begin to do that within USAID to formalize new training processes using modern pedagogy and distance learning for our missions and things and so that's really going on for us very strongly so I have a team, a member of my team who's worked with many of you PAMO level staples who's leading that effort to do more training and sensitivity I would say that there's also the other side of that coin is how do the faith based organizations provide the literacy training towards working with government 101 and 201 and 301 which is as we all know a challenge of it so Thank you all I have lots of questions but I think you all do too so let's open it up again we'll take about three at a time 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 I'm John Blevins from Emory University Jonathan Mann the perspective that human rights has to ground the moral vision 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 men who have sex with men work in LGBT communities work with sex workers work with people who use drugs they almost never reference the term and they actually have talked with us and this is a lot of us know this that around contentious issues the term and invoking human rights immediately becomes this 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 religious traditions and religious teachings to do similar kind of work one of the things I found really powerful at the World Bank meeting is Dr. Kim invoked a preferential option for the poor a perspective out of liberation theology and Roman Catholicism it fills to me that around finding a kind of common morals based on contentious issues that there are intersections that we haven't explored very much and I know that faith based leaders are working to do that in some ways in various parts of the world I wonder if you all 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 not abandoning it but expanding it. Denise Leonard open health systems how much when a USAID or somebody funds these programs are they also attaching to it the sufficient funds to then do the evidence based analysis of the intervention as well and are they making that I mean it seems to me like in the first part we were talking about evidence based interventions and faith based and I mean obviously funding for that kind of analysis is also important and how much is that attached to the packages. 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 the going beyond extending including human rights but going beyond that term Sandy do you want to start off? I think that you know again there's been some really interesting work done over you know on this around better language and better words and you know defining the way that we talk to each other about these kinds of issues but you know it's limited and I think coming out of the conference we've had a lot of dialogue about this coming out of the conference yesterday I think it's clear that we need to spend some time looking at expanded kinds of language that works for everyone and that's not polarizing in and of itself I mean we all you know 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 can't you know we're not we have to keep moving on in the common language as more partners come to the table I think it's something that we need to invest in and we really have it in a conversation that I'd love to have with colleagues going forward for us in PEPFOR and I know for others because again if these partnerships are going to work like we need them to work then we have to invest in figuring out what the you know what the foundation of that looks like and then you know to come to 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 I mean we don't if you don't speak the same language as somebody you have to work on understanding so how people speak about a situation or a group is clearly there's 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 DC as well as in Africa about language and how to approach it and how to make the case that these were harmful laws and there was one of the discussions that kept coming up was LGBT rights or human rights and human rights some said you have to really focus on human rights and that's what's going to speak to a whole sector of society that will not necessarily be part of an LGBT rights discussion so I don't think it's clear it depends on communities and obviously there are religious leaders where human rights languages is also the language they use but to your point we have not cracked this not at all can I say on this a resource I don't think we in USAID have used enough or a place to turn is our Foreign Service Nationals which are the people from the countries in which we're working who will work for USAID at a long period of time decades often and they are rooted in their own communities they're often from the religious traditions we're talking about and they often have the set of relationships certainly for longevity when foreign services officers rotate after a fairly short number of years so I've come to appreciate my three years the role and how do we figure out how to better use and work with our Foreign Service Nationals to address these questions of language perspective and relationships Mark maybe you also want to take the first crack at the question about funding for the evidence so I think that where you get into now is the difference between evidence and evaluation and certainly we're there on evaluation that's built into our requirements of our funding we don't tend to fund a lot of evidence and that's a gap and to be honest I don't know where we're going to solve that you know we talked to our budgets are largely dictated by Capitol Hill and so maybe it's a conversation there as well but we're good on evaluation we're not so good on evidence Sandy I think this is it really is 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 into only having the monitoring evaluation that Mark talks about I think that's a conversation we really need to have and it's not an easy one because again you know we're all funded by the US Congress and we have our own sort of challenges around that it's also a place where I think that advocacy on the part of our faith-based partners can be very helpful for us to say that there is we have all this anecdotal data but we're hamstrung by the fact that you're asking for evidence that we can't pay to get and see if we can't be a little 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 I neglected to give I think a positive story though USAID has funded the Institute for 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 for family planning obviously we're going to have a whole lot of other tools but that particular tool is acceptable by many religious groups that are 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 Jenna Karp, I'm here from the State Department and it's 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 year or two years Good morning again and I my name is Rosemary I can just go back to the collaboration how do we collaborate with the USAID, with PEPF I want to thank PEPF I met President Bush before he left office in the faith test initiative in 2008 and we talked about the same how do we come up with this collaboration of outreach advocacy in the rural areas so they are in Africa and as she said lessons learned on Ebola because there was no mechanism of outreach, advocacy and education to people so local people, CPOs play so much, do so much work on the ground but nobody gives them a credit and nobody funds them so we should look at the CPOs and the local faith-based organization in the rural areas the big judges don't want to work with the small organization and the small organizations are the ones who do a lot so USAID, PEPF and you know look into that and follow up to the ground because we do a lot of work and how do we collaborate again, thank you Well the questions will 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 the 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's a little bit more difficult for us to do it on a global with global reach than it is to do at home with domestic reach but certainly faith-based organizations and other private actors have to be partners and any kind of of emergency preparedness or pandemic preparedness and I think people are very aware of that certainly in the aftermath of the Ebola epidemic and you know the faith-based organizations were on the ground responding to the epidemic before anybody else could figure out what to do. One of the things I think that's come up in our conversations around emergency preparedness 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 that 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 responding 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 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. Do you want to come in? I totally agree. The preparedness side of the equation which has always been harder for policymakers to focus on the response to crises is much easier so that's a whole other event to discuss but just what will be important is to look at going forward to what extent our faith organizations and leaders involved in preparedness now because there's been so much more attention to the need to have better preparedness because of Ebola and there's new money available for that. I will say in 2013 I was just looking back there is a funding line that USAID has to look at emerging threats and preparedness essentially very few NGOs get money in that regard and there's reasons for that. No faith-based organizations got disbursements for that in 2013. This is pre Ebola so it will be important to look at that going forward I think. One story on small whether you work with small groups or not former administrator Shaw when he went to Liberia met with a small orphanage in school that had to basically shut down and needed food for many other students. So this was a very small operation and there was some moment that we really want to go there. It also turned out that the pastor that ran this had a national radio show that covered the country. So at first glance was small became very big because he was able to send messages out and was very lively so I think we have to be open to being surprised and being careful when we think something small because it may not be so small actually and the influence that can go out. I think we are in terms of the second phase of Ebola response and we want to build back better USIDs in conversation with the international part of the Catholic Health Association and seeing if there's a way we can partner on health system strengthening about Ebola about an ending child and preventable maternal preventable deaths I think that's also a key to try to reach some of these organizations Sandy mentioned Catholic Health in terms of doing health system strengthening across the board with faith and non-faith organizations together to build in the resiliency to take these shocks and respond appropriately and not get set back so far. Any thoughts on the collaboration piece? We've talked a lot about that up to now but any additional thoughts on collaborating with community based organizations? That last question. I think again that we have to continue to expand our capacity and that really has to be done because big governments will never have the capacity to directly fund very small organizations that's just not, I mean we don't have the bandwidth to be able to do that as much as we would like to because we recognize that's often where we get the best return on our investment but we'll continue to rely on robust coordinating mechanisms organizations that comprise many different faith based groups so that we can get the money to the ground. I think that's certainly the way that USAID does their funding and I think it's the best of what we've got at the moment. I think there's always room for improvement and again 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 just in these last couple of minutes that we have I'd love to give you all a chance for some final comments but also ask you to reflect on precisely what are the next steps including to address some of the hard issues. I mean the paper in the Lancet that talked about the challenges about child marriage, about gender based violence, about gender about family planning and reproductive health. There are some very big issues that the US 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 US goals in that area. So when you're thinking about next steps please include how to address these big challenges. Jen, do you want to start us off? Sure. I think this echoes what a lot of the authors said and others have said in the audience and the panel that looking at the next sort of phase of US global health policy and global health more generally and STGs with a I think a better at least articulation that we have to reach the poorest of the poor that we can't have the world we want if we don't. Faith based organizations and religious communities have always done that in a way that other groups haven't always been able to. So I think we can't reach those goals without their integral involvement. I think that's been pretty clear in the evidence and the paper shows that. So that's one. I think around the challenges we have to name them and the article does that. I think naming them and talking about them and trying to understand where there's common ground where there's difficulties in figuring out ultimately with a goal of getting services to people who need them from public health evidence based services to people who need them is the end game that we want. And lastly data we need it. We just took a cursory look for it. I don't know if it's a good idea but I'd like to do more on that. I think Kaiser but all of us who can should. I think that's really critical. Mark. Where you live often shapes where you think. So where I'm located within USAID I don't see the negatives as much as the positives because we're flooded with great opportunities in how to engage. We get frustrated sometimes we can't take all of them but to be honest we were to see the partnerships that are going on are just really important and so I'm very positive on this. I think in terms of addressing the challenges it is the faith communities can be the trip wires for the challenge and the solution at the same time to the challenges. So on gender based violence for example we've had conversations with the chair of the North American council of Somalia moms and he's very interested in working with us on addressing gender based violence in Somalia taking the networks that the moms here contain in Somalia and in the communities of Somalis in Kenya and Ethiopia and other places and so he's already reached out to the head of mom in Somalia to say will you work with me on this and there's an agreement there. We're not working out how to make that happen there's some private foundations that want to come together. We want to look at that the mom came to meet with us at USAID a couple weeks ago I'm going to go out to Minneapolis to speak with him directly. So I think we can take the mechanisms we have for public-private partnerships work with faith-based groups and other folks and use the religious leaders to answer the challenges that may come out of this community. I just want to agree with what the other panelists have said and just add a couple things. One is that we certainly need to reach the poorest of the poor but I want us to not leave the very marginalized for other reasons behind and which makes it a much more difficult conversation for us but it's actually necessary certainly in HIV and AIDS and other issues as well. The other is to focus on the importance of literacy and cross-training of public health practitioners and faith-based practitioners and this we've had some great pioneers like Jonathan Mann like Bill Fagy that's sort of an icon for some of us in public health Jimmy Carter and others who recognize the importance of this 30 years ago and started work on this. So there is a very robust small body of work on cross-training our practitioners and people on the ground to talk with each other and to find some of that common language that John was talking about so that helps us have we have to have the same language to have a conversation about particularly sensitive issues. It's always a challenge but just to end on something that a trend that I see in academia and elsewhere that I think speaks to the future in a very important way and that's this incredible growth that we have seen on faculty with John and Emery that we have seen in interdisciplinary approaches to development, to public health and to theology that include all of our schools and also a real growth and dual degree programs and theology and public health and development and theology and all of this cross-training that I think makes me very hopeful about what the leadership will look like 10 years from now and 15 years from now on these kinds of issues that we all hold so dear. So I think there's a lot of there's a lot of bright light on the horizon when it comes to new leadership. Well, I think this has been such an interesting panel and I think it opens the door for, as the first panel said, so many more conversations, so much more happening in the field right now and great thanks to all of you for the work you're all doing in this area and for sharing your insights with us because I think this has been very, very enlightening. So please join me in thanking our panel. Thank you.