 Well, welcome, everybody. Thank you so much for coming on this beautiful summer day. And welcome to our viewers online as well. My name is Janet Fleischman. I'm a senior associate here at the CSIS Global Health Policy Center. And we are delighted to have guests and speakers here today. And I think you have their bios on the sheet that was outside, but I will do a brief introduction. I also want to say a few words of thanks, first of all, to Katie Peck from the Global Health Policy Center for all her help in organizing this event. And also to Mona Bormet from the Christian Connections for International Health, who have collaborated with us on this event and who have been responsible for bringing our guests here for their annual conference, which is taking place this week. So thank you to CCIH as well. We are quite honored to have these two speakers from Kenya joining us. We organized a similar event last year. And I believe one of our speakers from last year is here today is Tony here. There he is. Welcome. This is Dr. Tony Tumasigue from the Ugandan Protestant Medical Bureau. Thank you for joining us, Tony. And we're very eager to continue this discussion about the role of faith-based organizations in advancing access to voluntary family planning, information, and services, as well as to learn about new efforts at mobilizing greater interfaith advocacy for family planning. Today, we'll be looking specifically at Kenya, where faith-based organizations have been active for a long time in providing health services, as well as focusing in on maternal child health services, and part of that being family planning. The Christian Health Association of Kenya has over close to 600 health facilities and programs. And if you put all the faith-based organizations together in Kenya, there's over 1,100 health facilities and 27 medical training colleges in the countries. And faith-based organizations provide some 30% of the total health services in Kenya. And in certain counties, it's even higher. So clearly, the role that's played by faith-based organizations in providing health services is extremely important. And the importance also of faith-based organizations in providing information and access to family planning is also important for them to meet their own health goals and also to meet the needs of the women and girls in their communities. This is also a very interesting moment in Kenya with a lot of important opportunities and some very big challenges. And we know today that the Kenyan government has initiated a process of decentralization that they call devolution. We'll be hearing more about that, but it's really shifting the health services from the national level to the 47 counties. And that presents also new challenges that we'll be hearing about from our speakers. We also want to hear more about how the religious leaders are engaging in maternal health and family planning in their communities, how they're partnering with the Kenyan government, what support they're getting from other development partners, including USAID and other US-based donors, like philanthropic organizations, the Bill and Melinda Gates Foundation, the David and Lucille Packard Foundation. There's a lot of interesting connections on funding from the US that we want to hear more about that focuses on these issues of family planning. So let me introduce our speakers because we have lots we want to discuss and then we want to open it up to questions from all of you because I know you'll have plenty that you'll want to hear about as well. So first, we have Dr. Samuel Mwenda, who is a medical doctor specialized in health systems management. He has served for the last 13 years as the general secretary and CEO of the Christian Health Association of Kenya called CHAC, which is a national network of Protestant churches, health facilities and programs all over the country. In this position, he's responsible for the strategic leadership of CHAC, secretariat, partnership building, resource mobilization and advocacy. He is also a member of the Health Sector Coordinating Committee and the vice chair of the Kenyan CCM, the country coordinating mechanism for the Global Fund. And to my left is Peter Munene. He is a social worker by training and the international program coordinator for the Faith to Action Network. Peter has 18 years of experience in advocacy and implementation of programs, specifically targeting marginalized groups with a focus on economic empowerment and protection of rights, including combating child labor. From late 2005 to 2012, Peter worked for DSW in Tanzania and then later in charge of advocacy for Africa and Asia. And in 2013, he assumed the coordination of the Faith to Action Network, which is a global interfaith network in support of family health and well-being. So we thank you both very much for being here. And to begin with, let's just start out hearing a little bit more about your organizations and the work you do on family planning. Samuel, do you want to kick us off? Thank you very much. The Christian Health Organization of Kenya was started way back in 1946. It's a national network of hospitals, health centers, dispensaries, community-based healthcare programs that are owned or operated or supported by various protestant churches in Kenya. We are involved in health service delivery at those different levels. We follow the guidelines that are laid down, policy guidelines by the Minister of Health, and we are regularly engaged with the ministry in matters of policy, matters of guidelines, regulation, and in programs. So our services are comprehensive. The target, we have services for children, for women, for young, for adolescents, for adults. Very specifically, we run maternal and child health services, which includes anti-native services, delivery services, post-native services, but also family planning. The protestant churches have no health facilities, do embrace the entire range of family planning options and methods, so we provide counseling. We help women and men make choices on the methods that are appropriate for them, and we provide those services as appropriate. Thank you very much. I have lots more we want to hear about that, but Peter, do you want to tell us a little bit more about your work on family planning? Yeah, let me just introduce the Faith to Action Network by letting everyone know that Faith to Action Network is a global interfaith network. It's a network that promotes health, and especially the issue of family planning and reproductive health. Which, in our own language, we call family health and well-being. It was started in 2010. The efforts to start this particular network started in 2010, but for Marie, or the blessings for the network were given in 2011. And we are now an established network, a regal entity, with a head office, if I were to put it that way, in Kenya. But our members across the continents, our current bond is also sprained, it's based on organizations. CCAH is a founder organization of the network. We have other organizations that are in Europe and in Africa and Asia. What we do specifically on issues of family planning is building the capacity of religious leaders, on issues of family planning, so that they become better advocates, champions of family planning. We also do a lot of advocacy, and advocacy both internal, within the faith, and also external, focusing on governments, and focusing on donors and other agencies, so that they become more inclusive in terms of participation of the faith community in policy and decision-making that relate to family planning and reproductive health. Internally, we try to get more faith acceptance, more faith acceptance, more faith leader support for family planning and reproductive health. So basically that is a faith-to-action network. And just to interrupt for a second, can you clarify which faiths are involved in the network? We have Muslims, we have Christians, and Christians, we have Catholic, we have Protestants, we have Hindu, we have Buddhists. And within Christians, as I've said, we have the Catholic, we have the Protestants, we have the traditional, or the African-instituted churches especially in Africa. Those are the independent, we call them independent churches. Maybe you can tell us a little bit more about why faith-based organizations like CHAC should be involved in family planning. Why does it matter for the broader set of goals of your organization and the health needs of your community? From a health perspective, because we are a health-oriented organization and we work with health facilities, we know there are major health benefits for helping couples and women have the right timing or their pregnancies, their appropriate number, rights, spacing. Sometimes we know there are those who have health issues that would best benefit from, a particular limit in terms of pregnancy that they can have. But also as, because we value family health, the well-being of the family as religious organizations. And we know the family well-being, the parents, the children that come into families depend also on the ability of the parents to take care of their children, give them good nutrition, give them good health care, ensure that you see all their immunizations on time, give them good education, and help them to build a foundation in life. I think this creates a very strong justification for the churches to get involved in promoting. Family health, family well-being, and family planning being a critical intervention. What are some of the complications that you have, some of the challenges you have in bringing religious leaders into the discussion about family planning? Within health facilities is no problem because the health workers understand the value and the importance of family planning. I think when engaging religious leaders, one of the challenges that they are training and their background, most often, does not, has not given them opportunity to learn about the role of family planning in promoting good health. So there's a capacity gap. And we tend to have a lot of expectations on the religious leaders, assuming that they are knowledgeable in everything. And expecting that they'll give correct advice in an appropriate way and give a message in a sensitive way. So one of the challenges I see is the need to help them acquire the right knowledge, the right information, and be able to have the best communication and tools to be able to pass on the message to the diverse communities that they serve. And from your perspective in the work you've been doing with the Interfaith Network, what did they bring to the table when you can get the religious leaders involved in some of these issues of family planning? What benefit does that bring to the communities that you are active in? I think one we have to appreciate and realize the power religious leaders have, the average they have when it comes to people that they serve, the congregations that they serve. They are with them nearly on a daily basis. And they have even specific days that if it is on a Friday, if it is on a Sunday, that they meet with them and they meet with them very entirely. Now harnessing that power and the leveraging on that opportunity is what we look at when we are looking at how they can serve the people in giving them information that is helpful in for their own well-being. What we have seen is that as Dr. Lee has mentioned, Dr. Terry is Doctor, now you think Swahili, is that the moment a religious leader gets the right information and the right tools that they can use to communicate to their congregation and pass the right information, they are really very powerful in terms of mobilizing people to support, mobilizing, creating demand for services, making people aware of the services that exist and where they can get those services. The challenge that there is, is that with religious leaders, they are also coming from different backgrounds. They have different levels of knowledge, different levels of education. They are also coming from different belief foundations. And those belief foundations also carry with them certain positions when it comes to the issues of family planning. Now, the importance of bringing different religious leaders together is that they share from different phase. They share what has worked in their own context, how they have approached certain problems or certain difficulties, where they have had successes and that sharing helps the different religious leaders to be able to replicate and occasionally even to take those practices, those examples that have worked well, best practices that have been seen to work and replicate them and even scale them up for their own congregations. And I think that is the beauty. The other thing is that once they come together at the point of sharing and they are from different phase, it becomes like a melting point. The issues of the restrictions each of them would have in their own phase. At that particular point is lost, they are discussing the issues. And what they leave that particular meeting with or that particular gathering with is the skills on how to handle those issues that they are facing in a different way. We were talking about some of the lessons of HIV and the engagement of the religious leaders and certainly the religious health community in the fight against HIV and the potential to bring some of those lessons to advancing access to family planning. Samuel, do you wanna talk for a minute about what you see as the lessons in engaging the faith leaders on HIV and how that might translate to family planning? Yes. When HIV pandemic hit Africa, and I think we're all struggling about how to package the message about prevention and what are the causes of HIV spread and how those could be mitigated. I think the religious communities face challenges because the way they understood and perceived and went about communicating the message ended up being very insensitive to people who within their congregations or their audiences were actually sitting there and they were living with the virus. So stigma was a very major challenge. And so for some time we saw faith communities and religious leaders as a barrier, as a problem. But when we realized actual weakness was that we are not empowering them. We were not helping educate them, get them to realize the best way of communicating and how we are all affected by HIV. They turned around and became very critical champions. And because religious leaders and places of worship are all over, in all communities, in urban areas, in slums, in the rural areas, we, they became very effective sources of support in terms of passing messages, but also encouraging people to come out for testing but even offering spaces for services within the premises of the places of worship. So what I see is just recognizing we need capacity building. The other realization was that religious leaders are different levels of education, of exposure, of knowledge, and they could not all be handled the same. So taking time to not only expose them to one training or one or two, but have a process of engaging them. Continue to empower them, provide them with tools and IEC materials, information they can use to pass messages to appropriate groups, age groups, people of different gender and so on. So I see this time around in farming planning, there are great lessons we can learn about how we can engage religious leaders and faith communities in a sustained, in a continuous way so that they are effective, they become advocates, they become channels of passing the right information. And also look at how they have been able to manage passing information to different age groups in their own space. Because sometimes one of the challenges that we have in churches, in mosques, is that you have a very mixed group. We have our children there at different ages, we have their parents, we have their grandparents, and it's not sometimes a good space to pass certain messages, particularly in African context. But when we have groups, women's group, youth, there's a much better space to engage with them very deeply at their level and in a way that a message can reach them well and they are able to open up and engage with us. And Peter, do you think that there are lessons for the family planning communities based on the experience of HIV? There are a lot of lessons. When you look at the role that faith leaders and religious leaders have played in dealing with the stigma. Because initially they were considered to be even sources of stigma. But the way they have been able to turn around with the right information, with the right skills, and be able to be the sources of protection for those who are positive, is something that can be used very easily to support the issue of family planning. Family planning and HIV ends, to me actually are reproductive health issues. And the only difference that came in is because of the need to respond to this particular issue that emerged at some point, which is HIV ends, and the resources that were in it, that tended to separate the issues. But with the coming in of integration, these two issues can be dealt with in a relatively easy way. And religious leaders are very, very powerful when it comes to the way they can handle some of these issues. I want to give examples. We did training in Addis Ababa in 2013 for religious leaders on the issues of sexual reproductive health as it relates to young people, the needs of sexual reproductive health of young people. And out of that training, we were training religious leaders and other also representatives from faith organizations. Out of that training, we've seen a lot of changes with some of the religious leaders that were present. In the actions they have taken, in their own congregations, in their back home when they have gone back home, on the way they are handling issues of sexual reproductive health in terms of passing the right knowledge, creating opportunities for those who have the skills and those who provide services to come in and interact with young people and provide those services and provide the knowledge and provide the education that is empowering in terms of providing them with the right skills on how they can manage these issues. So the issue is not so much that the religious leaders would be resistant because they are also dealing with these issues at Congregation Revo. They are dealing with the teenage pregnancy. They are dealing with early marriages. They are dealing with the issues of living abortion because they are not immune to these issues. They are part of the community. The issue is once they are given the skills on how they can handle some of these issues, which some of the, where some of those issues have not been trained in the erogical schools, then they are able to address them and actually they appreciate that they have gotten additional skills on how they can manage the community because they are managing people in a holistic way. They are not managing only the spiritual. They are also managing the social, the economic and all other complications that come out with an issue that people are facing. So they are very, very hopeful. Well, I think just picking up on this issue of integration is a very important one, of course, as a service provider. But it also links in with some of the challenges and complications of resources. As Peter was saying, sometimes it's different funding streams and different complications in bringing these services together. Can you describe for us from the CHAC perspective, how do you promote integration and how important is integration for the women that you serve? Integration makes it easier to access a package of services. For a while now, we've had the whole package of maternal and child health services put together in the one room. So you have, we have clinics that are called MCH maternal and child health. Sometimes they put stroke family planning because that's part of maternal health. But they provide services for netto mothers who require netto clinic services. They provide netto care services. They provide family planning, counseling and services, and also immunizations for children and growth monitoring. So that is a very successful area of integration. Now, the other opportunity for integration is the whole area of HIV management. Particularly because preventing mother-to-child transmission is a part of the package that is now routinely provided in anti-netto care services. So an area I think that we can strengthen integration is to make sure that family planning information and counseling services are also provided within our comprehensive care clinics which provide HIV services. And then empower the maternal and child health clinics to do HIV testing, counseling and testing for the netto mothers who require PMCT services. So they don't have to be referred across to another building or another health facility to get out of a particular service. As we do this, because there's been a bit of resourcing for HIV services, including mobilization at community level, we can actually leverage those opportunities to also include family planning messaging for the outreach services, for community health workers who are doing HIV work to provide information as well about family planning. Do faith-based organizations have a particular role to play in that community mobilization? Can you speak a little bit, either of you, about the importance of faith-based networks in communities to pass these health messages, including about family planning? I can try. We have a number of experiences. We have a couple of projects that go beyond the facility. And that's because of the realization that sometimes we have services, but the demand is not there. Because the knowledge about the service or the knowledge about when one needs to seek the service may be limited in the communities. So two approaches we use. One is to recruit, train, empower and send out community health workers who are volunteers that live within the community. And they know other people live in the villages and they can be able to reach them, reach out to them with information about the service. Another strategic opportunity that we have as faith-religious institutions is that we have the religious leaders and the places of worship. So the churches that we reach out to provide them the training, the orientation or the service that we have. And try to use the structure that already exists, meetings that already exist, which always tend, there will always be some gathering of people at least once a week or several groups in a week. And those creates opportunities for passing public health messages, which includes giving them information where they can find the actual service. And family planning will be one of those. The reason being, when people are sick and hurting, they will look for a place where they can be helped because they are sick. And that's why the hospitals are there. But for a promotion service like this, sometimes if people don't have information and they are not well informed how it helps in the long run, they may not come out to seek for service. They may not even know what options they are available and where they are. So reaching out, it's a very critical component of helping people come to get their appropriate service. There's also the whole piece of policy in Kenya that's evolving. And perhaps you can speak a little bit, Peter, about the work in advocating with the Kenyan government and describe a little bit about your relationship with different structures in the Kenyan government to try to encourage support for family planning. I think when it comes to working with governments, there are many opportunities that exist for the faith communities. Religious leaders to be engaged in decision-making and policy-making. I think Dr. Mwenda Duruchak is participating already in a number of government policy-making processes through technical working groups being part of technical working groups. He has mentioned, for example, that he is the vice chair of the CCM, Country Coordinating Mechanism for Global Fund, but we also have situations where religious leaders themselves, depending on the issue of health that is at stake, engage with the government, engage with the leadership. Whether at ministry level or even sometimes seeking the political will of if it's the president or the deputy vice president or the governors that because we have now devolved systems in Kenya or the governors, all the wives of the governors sometimes because those are the easier ones to use to engage the governors or to get the support of the governors. So there are different levels of involvement. It just depends with the issue. But I want to mention that a lot of issues that where we have hand communities not fully understanding the health implications, the health benefits of a service, whether it is vaccination, whether it is family planning, whether it is on HIV ends. When that message has gone through religious leaders and the religious institutions that exist whether it is churches or mosques or temples because they always pass this information to the congregation, the congregation has been very semi-mobilized. It's very semi-mobilized through religious leaders because of the space they have and the voluntary nature of people coming because I am an Anglican, I see and I'm also a church elder and every Sunday we have announcements and the announcement that we have are both internal and external. Any announcement that is coming from the government if it is the minister of education, if it is the minister of health and they want to pass a specific message, it comes, they pass it through the church and it is announced as part of the announcement that will be made and people are encouraged to make sure that they participate. If it is, for example, a free medical camp or they are announcing that there will be vaccinations and they are always encouraging people depending on the message that is there. So it's very easy for family planning equally to pass on these messages and through the existing infrastructure because this infrastructure exists and it's free, it's free to use except now when it comes to technical, the technical knowledge that would be maybe creating confusion or bringing issues of misperception, that is where we are talking about capacity building and empowerment. Maybe I could comment on devolution and how it affects health in Kenya. In 2010, we adopted a completely new constitution which introduced a new governance system which has a national government and 47 county governments. And each of these county governments has a structure which is at the top, we have a governor who is elected by other people and his deputy. We have an assembly and we have an executive which takes care of various services. In the constitution, it was specifically written that health will be totally devolved which has separated roles. The minister of health at national level is only now responsible for policy and regression and training of all the workers and a few, just two, three national referral hospitals. The rest of service delivery is the responsibility of the county government department for health. The implication has been that the counties are now responsible for identifying their own priorities in health, doing plans and budgets and determining what budget they allocate for various health interventions. What is, as now brought about, is the need to be able to help the counties appreciate the health burden in their counties. And how to use the evidence to prioritize interventions. And clearly looking at the health indicators, including family planning and met me, the coverage, the total fertility rates, there are a lot of differences across the 47 counties. The counties which are doing very well, the counties are doing very poor. In fact, in the very recent past, we've had that mapping done. And because there are 15 counties which are having very poor maternal indicators, there's been an effort to get the top leadership, get to commit to prioritize interventions for maternal and child health. So through the support of UNFPA and the minister of health, these were brought together. The information was presented to them, the facts about the situation. And the governor felt the challenge that they needed to include maternal and child health as top priorities in their own counties to allocate more resources, to encourage more partners to come and work with them in order to try and improve those indicators. And it would be interesting, I was gonna get exactly to that new effort in Kenya to engage the county leadership, but also coming from the president, the first lady raising these issues of the importance of maternal child health. How much is this a new reality in Kenya? How important is this in Kenya? And how much is family planning being included in this broader discussion on a high level platform about maternal child health? Certainly we are at an exciting moment. In Kenya, we have a first lady who has decided she would dedicate her energy in creating a lot of awareness, mobilizing support and resources to address maternal and child health challenges. So she has launched what is called the only zero campaign. And it's basically targeting to address the causes of maternal mortality and infant mortality and childhood mortality, as well as a prevention of HIV transmission from mother to child. She has used our position to try and encourage government to allocate more resources. In fact, the president announced free maternal services for mothers needing to deliver in public institutions. The government has allocated resources for that. But she's also raising funds, creating awareness by running Marathon. She has done it in Kenya a few times, three times now. And what is very exciting is just how people come out and how it receives a lot of publicity and which it receives a lot of media debate and prioritization. She has also recruited the spouses of governors who, and you know, governors are leading their own counties and have all the responsibility for their people to be a part of that effort. So I would say it's a time of, we have very good political will and a lot of momentum led by the first lady. She did the first year, we thought she would stop there. But she actually has a plan. It's called a framework for engagement in maternal health, child health, and HIV prevention. And it's a three-year plan. And she is continuing this year. The money she raises, she's been equipping clinic, procuring mobile clinics and equipping them to be able to provide even delivery services out there in the villages for those mothers who cannot do the kind of facilities. Is there a family planning component to that? Yes, family planning is one of, among the components is to address barriers to accessing delivery services, but also promoting family planning as a critical intervention for promoting maternal health. Interestingly, the same, after the governors came together and also made a community where they committed to support maternal and child health, there has also been a national effort to bring together religious leaders from different religions for support of maternal and child health. Again, that effort was led by the minister of health, UNFPA together with the inter-religious council of Kenya. And a number of other agencies, World Vision was involved and a number of other other check it was involved, Faith Action Network was involved and a number of other faiths equally were, and networks were involved. And through this particular conference, the religious leaders themselves committed to supporting maternal and child health. And maternal and child health, including family planning were the aspects that were being discussed. And they have come up with equally a commitment on how they would want to go about it. The issue is that with some of these commitments, which are political, gaining that political goodwill, there needs now to be the follow up support for the services that they require, which is what we have seen when we have trained religious leaders and they become real champions, promoting family planning, promoting a sexual reproductive health within their communities and the need for people to go for services. Sometimes the services are not as quick to come. And those that provide services are also not readily available sometimes because of resource constraints. So that's the gap I think that currently exists in creating demand. You create demand and people come out to seek services, but maybe the services themselves are not readily available. So I think that the matching of the creation of demand and the availability of services is one area that needs to be worked on. But the good thing is that at least you have them creating demand. Which is the initial challenge. The challenge of now matching the demand and services becomes another one to address in a different way. Well, and that's a huge issue with devolution because now the counties have to be procuring the commodities and looking after their health systems in a totally different way. Can you speak to any concerns or at least challenges that they will face in ensuring that the family planning programs have the resources, the budgets, the commodities that they need, including the full range of family planning contraceptive commodities? Yes, it's certainly going to be a challenge because these counties don't have enough resources to meet all their health needs. We have many communicable diseases. We now have a huge growing burden of non-communicable diseases. And we have maternal and child health services that require commodities. So as we go, as we are going to counties and counties have their own set of priorities. In terms of challenges they see every day. People dying every day because of various disease conditions, I think it will be, we need advocacy for the different elements to be put on the priority list. We also need to help with support where we can in terms of additional resources that are dedicated to certain services. Because even when national level has been procuring, they have been having quite a lot of support of these commodities supported by partners. German governments have been supporting quite a lot. USAID has been supporting and a few other partners. So I know there are discussions going on that some of the public health commodities should actually be managed at national level. So that we can coordinate whatever support that's coming from some partners and also put in the government investment in them so that we look at the total national needs. But even your commodities, we need health workers. We need community health reaches, need education and so on. So I would see the need for us engaging the county health management teams to ensure that these needs are actually being prioritized in the competing resources that they have. And is this a message, especially in the advocacy realm, that your organization is putting out there? Yeah, I think there is one appreciation that we need to have about counties. One that the revolution is a very new concept in terms of the and also reality in Kenya at the moment. They are only now three years old. And some of these counties that have been, when they were created, they were created starting from ground zero. And the challenges that I imagine now that people themselves are identifying their own issues and they have government that has come closer to them. They have people that they can question that are closer to them because they have MCAs, what we call the... Member of county assemblies. Yeah, member of county assemblies who are closer to them. It becomes a totally different issue because the issues that are emerging from the communities are nearing at grass root level and they have leaders at grass root level who are responding to these issues. So the competition really in terms of priorities is very high. And some of these, the counties are also, you know when you create entities, they assume a personality in a way. They want to be like, maybe what you want to be like Nairobi. Garisa wants to be like Mombasa. But Mombasa when it was created as a county has found certain infrastructure already existing. It's not the same case with Garisa. It's not the same case with this Euro. So they are starting at different levels but they want to catch up very quickly. So to catch up very quickly means they are trying to do their ever best to be able to match their peers in terms of counties. So that in itself, when you are now doing advocacy for the issue of family planning, you need to do that advocacy and possibly even link those counties with where they can get some of the additional resources because this requires additional resources for them to be able to prioritize it and put it on the agenda of issues that they are dealing with because they are dealing with a lot of public opinion and pressure from the public on the public wanting to be like the other counties. So it's a challenge but it's also a challenge in terms of advocacy because this type of advocacy and the need for the linking of advocacy with resources has not been the advocacy that we are used to. So we are doing advocacy that requires us also to wear the shoes of the governance, to wear the shoes of the county when you are looking at the county and where it is and in terms of its priorities so that you can find out where would be, where would the resources for this come from so that when you are doing advocacy you are saying you can also link to this kind of resources to be able to provide for family planning and reproductive health. So I have many more questions but I know there's gonna be many questions here so I'm gonna have to limit my questions but I'd like to pull this back to two questions. One, given all these challenges where does the faith community come in and where does the importance of voice for faith medical groups in this discussion and link to that, where does the faith community contribute to these discussions about Kenya moving toward more sustainable family planning programs? Are there ways that the faith community is particularly involved in or could play an important role both in the advocacy for the resources that the counties are dealing with but also in looking ahead to find ways to make these programs more sustainable and more durable for the long term? Maybe to start and Dr. Lee will join. The issue is they are already existing infrastructure that the faith has in terms of already existing facilities. What is emerging is occasionally in most of the counties they are equally establishing merely parallel infrastructure in terms of health facilities. So there's the need for advocacy to say, Ruk, you need to do mapping to see where already there exists this sort of infrastructure so that you don't take resources to do the same thing to establish a facility that already exists in this area. And then the other element of advocacy is to see how these facilities can work in synergy, how the, instead of the county establishing a health facility when there is already an existing faith-led facility, how this particular faith-led facility can be empowered, can be expanded so that it can provide for also the needs of the expanded now clientele. That is a lot of advocacy that is required and it's also advocacy for the faith-led facilities so that they can now be more accommodating instead of only focusing on maybe the targets that the beneficiaries that they were established to look at. So there is quite a bit of advocacy in looking at existing resources and how those resources can be used for the betterment of the Raja community so that there is no duplication and establishing existing infrastructure instead of expanding whatever is available. I see the evidence that has been provided in terms of where we are at with our maternal indicators because that's one area that will not move very well towards the Millennium Development Goals and I know it's been contributing a key priority even as a country. And the fact that this evidence now is being provided also disaggregated per county. That should create the agency and the need to really look at how we prioritize. Number two for me is to ensure that these services are included in our strategic health, strategic plans, maternal health, strategic plans and action plans at national level but also at every county level because every county has its own health, strategic plans but also annual action plans against which they seek budgetary allocations. The third thing for me, I think we need to target to empower our faith network to do advocacy at different levels. This data is appropriate, the data we can do at national level but just like the government is devolved, we need to empower religious leaders at the other levels to be able to appreciate the need, to appreciate the problem, to appreciate the prioritizing that is needed and empower them how they can engage to help keep this as a priority. For the Philippines Service Delivery Network, the good thing we are all over the country in various counties. So for us, we shall continue providing services. We'll only appeal a support for capacity building, for strengthening of our systems but also for access to the commodities that actually required to provide the entire mix of fire burning services. Well, that leads to what I'll call my final question for now in terms of the US. Here you are in Washington. You were on the hill this morning. It would be very interesting to hear your thoughts on what was your message to the congressional offices that you visited and what are the changes that you see in terms of US assistance that may affect your health services? I think for me, the opportunity, this was an opportunity for us to say thank you to so much actually is happening in our countries, in Sub-Saharan Africa, because of the very good relationship that we have, the good partnership and the support in many ways. Some of that comes direct to our government. Some come through international NGOs. Some of that comes through the agencies. To those of us who are providing services through USAID, CDC, Water Read and the others. So we are very grateful for that support. And our appeal is that the investment in global health is very important. It is helping transform lives. It's helping save lives of children, of young people, of adults. And it's making a great difference. And it's one of the great things that you have known about out there is the involvement in life-saving, in life-transforming initiatives like HIV treatment and now the productive health, child health, and so on. You know, how that appeal is that this continues and this continues to grow. We know there will always be shifts and adjustments in policy and prioritization. But just also asking that sometimes opportunities are given for input from the ground. Because some of the realities we are discussing about disparities between counties, sometimes you can assume a country has moved. The indicators have shifted. But the reality may be that there may be pockets which actually need more investments, new innovations. And this is where we are appealing for continued partnerships, both technical, but also financial support, where that's possible, but through commodities and so on, for us to address and help improve indicate to the across the entire population. And for me, the other message was a health sector in Africa is not complete if you don't include public, faith-based, and private. Because sometimes we see initiatives that only target government. For Kenya, government only provides 50% of the health services. If you only work with government, you missed half the population. But if you combine public, faith-based, and private sector, you probably have covered over 95% of the population, of course, to the entire 100%. So one of my appeal is always consider this even as we conceptualize what kind of programs, what kind of interventions, which kind of partners we can work with on the ground. Well, I think that's a good way to end at least our initial discussion and maybe time to open it up for your input in the audience. What we'll do is take about three questions at a time. Please wait for the microphone to come around so the people listening online can hear. And please identify yourself and keep a question, a question, fairly short. And why don't we start in the back? Wait for the mic, thank you. Hi, very interesting. I'm Susan Newcomer from the National Institutes of Health. I would like to ask your guests how they connect with the apostolic and evangelical so-called owner-operated churches in Kenya, of which I understand there are a fair number, and which seem to encourage very early marriage and lots of children. Thank you, and we had another question just in the row ahead of you, I think. Well, thank you. I'm wondering if you can just share a story, because I think a lot of times, when you're trying to make a case, a story from the ground can really help, just a story on how a particular family planning initiative was not taking off until a faith community got involved, just to hear about the impact. One more question up here. Hi, I'm Shelly McGuire. I work for Population Reference Bureau. My question is related to male involvement in family planning, service delivery, uptake, education programs, and whether, from your perspectives and your roles, you've seen any particular effective methods used by faith leaders in engaging men in order to increase support for FP. Thank you, so a good first round of questions. First, the issue of some of the evangelical churches in early marriage, then the on-the-ground story of family planning successes linked to the faith-based involvement, and then, again, the male involvement through the faith community. So why don't we take those three for starters? Sammy, do you want to start out? Yes. The first question, I've actually not come across evangelical churches that encourage early marriages in Kenya. What I know is that we tend to have a lot of these from traditional practices, cultures, and probably more cultures from the Islamic side, and some of the traditional African culture. So actually, churches come in to encourage, to try and encourage parents not to send their daughters to school and not to send them off into marriage early, and sometimes create safe spaces, like within some of the pastoralist communities, where the young girls can actually take an in, and kept and helped to access education. If there are churches, we would definitely want to use our religious leaders network to engage their leadership, because this is even, government does not encourage this, because it not only affects health, and having many children, but also the girls miss opportunities to have education and have the best opportunities in life. So why don't we let Peter come in on that question as well, in terms of the harmful traditional practices, and early marriage in particular, and the work that you're doing? I think the issue of early marriage, I haven't come across evangelical churches. What I've come across is the African Institute of Churches. The African Institute of Churches, which we call independent churches, have this component is a bit mixed, because they also have a lot of traditions, African traditions and practices mixed together with the Christianity briefs, and therefore sometimes it's difficult to separate or to draw the boundary between what is really cultural and what is really religious in the way they practice, but it's not all of them, it's some of them. Now, what has happened is that there is now more opening in terms of dialogue with those African student churches, they are being mobilized to become members because we have a national body, which we call the Organization of African Institute of Churches, where because of that dialogue, once they become members of that particular organization, then they engage now on certain standards, certain standards in terms of re-target, in terms of practice, and among the issues that are dealt with and addressed include issues of early marriage. Now, with the Muslim community, again, there are a lot of sometimes scriptural misinterpretation, and these are not general, these sometimes are very specific to certain regions and certain areas, so what we have done at the moment is through the support of the Dutch government, Dutch minister of foreign affairs, and also support that is coming from a population action international, we are organizing what we are calling a caravan, and this particular caravan we are organizing together with a university in Egypt, Arazah University, it is one of the oldest universities in the Muslim world, it's over a thousand years, and it is really considered an authority on issues of theology when it comes to Islamic theology, and authority even in terms of the directives that come from it, it was one of the first Muslim institutions to come up with a fatwa on family planning, in support of family planning, so we are organizing a caravan, this end of July, in four counties at the coast, Mombasa, Kuare, Kirifi, and Ramu, where we will have some experts come from Arazah, and they will together with the Muslim leaders at the coast, and even some Christian leaders, they will go through communities trying to clarify, clarifying misperceptions about early marriage, about family planning, about reproductive health, use of commodities, different methods of family planning, because they are already considered as an authority, and therefore that's one of the linkages that we want to make to help clarify some of those issues, and address issues that have been persistent in that area, especially on early marriage, among others. So maybe each of you could take one of the next questions, one was about the engagement of faith leaders in sort of an on the ground story of success in family planning linked to the faith engagement, and the other was about faith engagement with male involvement. So each of you take one of the next questions. Let me attend the male engagement too. Our family planning programs, we are trying to encourage male involvement, in fact, some of our community members are actually males, and we found that where we successfully manage to recruit males to be empowered with the education, with the training, with the tools and resources, and involve them in communicating with their spouses, but with their peers, the uptake of family planning services is actually increasing. There are methods that health workers would encourage to get the spouses come along, whether, if they can be really, particularly the long term or permanent methods. It's, you have better confidence when the couple agree to it together. However, in rural areas, sometimes it's very difficult to encourage to get the women, get their spouses to come along. But as we are the kind of sensitization that we are doing through the training, we are here encouraging that men get involved. And one way that we found effective is also have them as the community health workers who are trained and they are going out to pass messages. So because it's much easier for them also to reach the men, maybe you can attempt the other. Do you want to talk maybe about a success in family planning that's linked to the involvement of the community? Yeah, I think, let me talk about how we are, for example, engage the traditional churches. We have, in this year, engaged with the traditional churches in Kenya by having, together with the organization of African citizen churches, a meeting of all bishops of the African citizen churches in Kenya, and a meeting of all the secretary generals of some of the churches, or the executive, depending on the time that they use, whether it's the executive or the secretary general of most of those churches. And the issue has been to discuss with them on family planning and discuss with them on how they can pass those messages. First, the acceptance of the message, and secondly, how they can pass the messages to their congregations. What we have seen is that a number of them have taken up those issues very quickly, because they were already issues that they were being, which were charging to them. At Rock River, and they are moving on with creating awareness, shifting the mentality of their congregation in terms of support for family planning, because what we witnessed is that in a lot of their congregations, women were having very many children, and the spacing was very, was very short but it was nearly on a year basis you would have a family which has children that are like, you know, they stay at case, you know. The way they follow each other is quite, yeah. So, they are taking up that challenge. I want to recognize, for example, the African Brotherhood Church, they are really doing a wonderful job in Machaacos and in other areas in eastern province. I want to recognize also the African Independent Church of Kenya. It's doing wonderful. We've seen a lot of changes in the way they are now engaging their congregations with messages, and of course, we do not know whether the congregation is picking up the message, but at least the leadership is engaging the congregation, and we believe because it's coming from their own leadership, people are going to be positive about the message. So, they are good examples that are taking place, and we have also seen the same thing because being a network, we also have members in Uganda, some that we have trained. We have very good examples of some bishops from Anglican Church, some revered from the Anglican Church who have not only engaged their communities in Uganda, their congregations in Uganda, but also started creating spaces, youth-friendly services in their own churches, and we have different examples of such leaders. We have Bishop Kazimba in Uganda. He's wonderful. Okay, let's take another round of questions. We'll start over here in the blue shirt. Garibu. Thank you. Asante Sana. I was privileged to work four years in Kenyon, family planning starting in- Please identify yourself. 83, pardon? Please identify yourself. Gary Merritt, USAID, ex-USA. This was a time when you all were just barely born, I think, but I remember it vividly. The following years, Kenya's fertility declined at the most rapid rate that had been recorded ever at the national level, up until around the mid-90s, at which time it plateaued. There was even some evidence that declined, that the prevalence of use of family planning declined, and there were consequent slight rises in fertility. I understand that unfortunate trend, which was the first time it had been recorded in any country where prevalence of use of family planning went up and then actually declined. There've been several instances since. My question, of course, is leading to, in looking at the long arc of family planning history in Kenya, is there anything about that period that you associate the period of leveling off and actually declining family planning that is associated with changes in religious environment or religious leadership? Or can you characterize how you feel faith-based delivery and leadership and promotion is affecting these broad trends in Kenyan family planning history? Thank you. Why don't you hand the mic right next to you? Hi, my name is Naveed Khurram from Konikistan Hospital in Pakistan. I would like to know about health workforce production by the CHAC. How many medical schools come under the umbrella of CHAC and are they fulfilling their health workforce needs? Thank you. And I think we had one more over here. Yes, my name is Russell King. I understand that Human Life International has recently done work in Kenyan. I believe they've advised the Kenyan legislature not to liberalize their anti-abortion laws. And so my question is basically, how do you make sure that your family planning policy is bi-o-ethically correct as well as consistent with Kenyan law? Okay, let's, we're gonna just take those three questions and see if we have time for one more. So we have the question of the leveling off and potentially declining of the CPR and whether or not that had anything to do with the religious environment. Does either of you want to take that one first? I would think having been the field over that period, I think the major difference was the investment in programs at community level. We used to have very intense widespread programs of community-based distribution of family planning. That's why we're resourced. We had community health workers that were trained, that were equipped, that even they provide information and refer but also provide us a method like pills and condoms. The health facilities were also getting regular training. There are many projects, well funded. So there was opportunities for continuous mentorship, training, but also resourcing in terms of some of the facilities that are required to provide services. There's also a lot of support for outreach services. I worked, the hospital where I worked, we had teams every other day. So we were able to reach out many, many people within where they live, with information, with services. And that actually was enabling us to reach very many people needed services. I think with the advent of HIV, we got competing priorities. And once it was declared a disaster, and yes, indeed it was having major impact on the health and lives of people, we found both our national government as well as a lot of donors shifting their priority in terms of investment to that area. So for me, I think it was not about the religious leaders engagement, I think it's just a shift in prioritization and the loss of investment at community level. I think also the workforce question was directed to you as well. Yeah, we, the fitness in Kenya have, we have two universities training doctors. We have another three hospitals that have residency postgraduate specialization programs, but we have 27 middle level colleges that train nurses, clinic officers and two that are training laboratory and pharmaceutical technologies. So we contribute, we are regulated by the regulatory bodies. So those that are trained through these programs, they are registered to serve anywhere in the country and even outside. And do you want to take the final question about the family planning and Kenyan law? I'll start with maybe just making a small contribution to the first question about family planning. When I was growing up, it's true as you're saying, when I was growing up, those 1990s, there was a major national campaign in support of family planning. As you are talking, I could recall some songs that we used to sing, which were on national radio every single day and would sing about that if a mother wants to regain health, they should actually space for three years. There used to be a song that space, for the husband, give the mother three years so that she can regain health and after three years she can actually think about another baby. It was a song that was done by a national band and it used to sing and everybody used to pick. That was the level of messaging that was there in support of family planning. Equally, as I grew up, I could see the red days in green. The red days in green, they were the ones who were providing community health workers. They used to provide family planning products, especially peels, condoms. And I remember seeing, let me say women, go to them whenever they were without the peels and get surprised. And they used actually to go visit homes because they used to come also at home and I would see them. Then of course, as the doctoria said, the moment HIV ends came, things just stand upside down a bit because there was a lot of resource shift from HIV, including from the personnel that was managing maternal and child health family planning. Most of them were trained now to provide HIV and related services. Now, with the issue of the Kenyan role and abortion, if I had you correctly, for the faith community, the issue of abortion is totally different. It's not supported by the faith community. What is in the Kenyan role is very different from what is in the practice when it comes to the level of acceptance of that particular provision within the role by the faith community. So I don't think the fact that it is different is a contravention as such. I would consider it to be an issue of engagement in terms of what does it mean because I think there hasn't been a lot of consensus building between what the role says and what the faith community believes. So that remains a gray area. Unless I tell you, you want to... I think maybe what we can do, we have Dr. Tony here. I just wonder if he wants to make any final comments from the floor given his perspective and coming from Uganda. Just want to give you a chance to say something if you'd like. There's a mic for you. I thank you very much. Just to say that in our context in Africa, Uganda, Kenya, there's a lot of dialogue that needs to be done to harmonize a number of things, especially learning from each other in terms of what is happening in Kenya within the faith network and also what we are doing. I think there is a need to harmonize a number of things and faith actually brings that component that will bring all of us together so that we don't see each other as people who are conflicting on the issue of family planning, for example, but being communities that complement each other. One of the things that I think is critical is to understand that some of the faith would favor certain methods and not others, but not look at that as a way of conflicting but assuring that everybody is able to practice what they feel and they're supported to practice what they feel is critical. Because at the end of the day, we are all able to ensure that all our families are having health lives. For those that support baby natural family planning, we should ensure that those commodities, specifically for natural family planning, are on the table and that a woman who goes to any facility is able to get the whole range but then choose which services they think is best for them but also providing for the faith that they are coming from. I think to me that is critical. Thank you. Thank you, Tony. So unfortunately, we've come to the end of our time. I wanna give our speakers a minute to say any last concluding thoughts before we wrap it up. So let's begin with you, Peter. I think to me, there is a lot of value and did they added value when people are able to be brought together? That's what I've seen with the network. The moment different faiths have come together, it really contributes to understanding. In fact, it contributes even to peace. That's what I've seen. I've seen a greater understanding, greater collaboration, greater partnership of even organizations that were not expecting previously to work together because of coming together, gaining understanding of each other and the different perspectives. The other thing is to me to appreciate those governments and agencies that have worked and supported the faith community in providing health services. The US government, the Dutch Ministry of Foreign Affairs, Norand, the Norwegian, the UK government, they have supported and many others including UNFPA. They have really supported efforts by the faith community, recognizing of course the diversity in terms of positions, the diversity in terms of services. And I would want to really encourage others to work together with the faith community. Of course, recognizing that the faith will not just shift in one day to become the very progressive and the supporters of total comprehensive sexually productive health services. But we can work with the faith over time because what the intention is to provide services to the people and the people who, whether they are practicing natural family planning, or they are practicing all the comprehensive methods of family planning, they are the same people that would want to have services reach to them. So we need to work with the faith, starting from where the faith is and then progressively we can maybe move towards them even differing where they cannot provide services, certain services to other areas where those people can get services. So I want to appreciate all the support that we have received from the different agencies. Tammy, the last word for you. I just want to appreciate the consideration of giving opportunity for faith-based institutions and religious leaders as key stakeholders in reproductive health. They are a resource that can make a difference, help us to get the next mile. My recommendation is that just like when public health, we develop projects and initiatives for health workers. We begin with a baseline where we are in terms of capacity, in terms of resources, in what capacity building needs to be done. And as after we do capacity building, we don't leave them there. We follow the map to see how are they doing? Where do they need to be strengthened? So we have mentorship. We have monitoring and evaluation. We have a process of continuous engagement. And then we monitor, we have indicators to keep tracking how we are doing. I think we need to think about a process like this in engaging and empowering religious leaders because they are all not at the same level. They don't have the same level of understanding of speed of learning. So when we understand where they are at as we begin to engage with them, as we have a program of empowerment, that's also a system and process of following them up to continue helping them, to continue addressing some of the issues they encounter when they go out to help us in promoting family planning, education and mobilization. Let's also appreciate them when they do well in making us progress. And where we can identify those who are very effective. Can they be champions? Can they be mentors? Can they be role models? And have a way of using them to help others to progress. So there is opportunity for me. And what we need is a process of investing in building their capacity but also supporting them to deliver. Well, this has been a fascinating discussion. I know that we could have gone on for much longer but I so appreciate you taking the time to come here to share your views with us and to engage with this audience. And I wanna thank the audience for such an interesting discussion. And please join me in thanking our speakers. Thank you.