‘BELIEVING’ IN HIV: The response of Christian Faith Based Organisations to HIV in India: ‘BELIEVING’ IN HIV: The response of Christian Faith Based Organisations to HIV in India Nathan.grills@sjc.ox.ac.uk


Slide2: UN Secretary-General, 2006 “A quarter century into the epidemic, the global AIDS response stands at a crossroads. For the first time ever the world possesses the means to begin to reverse the epidemic…But success will require unprecedented willingness on the part of all actors in the global response to fulfil their potential…to embrace new ways of working with each other, and to…sustain the response over the long term”


Slide3: This statement is highly relevant for FBOs, and could be rewritten…. “After a quarter of a century of a uneven response to HIV, FBOs stand at a time of Kairos. FBOs are an important part of the means to reverse the epidemic, but FBOs must show unprecedented willingness to fulfil their potential, to seek new collaborations and linkages, and to sustain the response through their significant dedication and grassroots partnerships”.


Presentation structure:: Presentation structure: Background and Study Rationale India Update Study methodology and limits Findings Recommendations ???Questions and abuse


Rationale for Study : Rationale for Study Growing ‘faith’ in FBOs to get to grassroots and deliver programs effectively Growing money being made available to FBOs to respond to HIV Growing controversy around FBOs Growing Number of PLHIV in India India HIV epidemic receiving more global attention


Study Questions to Answer: Study Questions to Answer “Would partnering more closely with Indian FBOs to implement HIV prevention, treatment and care programs be an effective approach to respond to HIV in India?” “Can better understanding areas where Indian FBOs encounter difficulties, assist donors and policy makers know how best to partner with FBOs to ‘optimise’ the faith-based response to HIV/AIDS?”


Update on India : Update on India 1.1 Billion People HIV Prevalence 0.9% 5.2 mill PLHIV (NACO), 5.7 mill (UNAIDS) The difference between the two 0.2% prevalence 1% prevalence increase is 5 million PLHIV 59% of HIV infections in rural areas 9% of those in need on ARVs Concentrated Vs Generalised epidemic


High Prevalence States in India: High Prevalence States in India


Doomsday Predictions!: Doomsday Predictions!


Study Sample and Limits: Study Sample and Limits


Defining an FBO: Defining an FBO Congregations- not my focus Religious coordinating bodies and organisations- partly Religious NGOs- my focus Religious CBOs- my focus (FOSTER, World Bank 2004)


Which Faith : Which Faith


Why Christian?: Why Christian? Methodologically Defining Hindu groups using FBO concept is difficult More valid to examine other faiths individually Pragmatically Practically


Which areas in India: Which areas in India 4 High Prevalence Southern States A sample of FBOs selected these high prevalence states What about the North East (next time?) Different epidemic Different religious demographics Relatively small proportion of epidemic


HIV Prevelence/Field Visits: HIV Prevelence/Field Visits HIV prevalence at ANC sites 3.0%


Methods : Methods 34 FBOs in South India 14 Co-ordinating FBOs 34 sight visits, 45 interviews 245 pages of transcripts and notes 121 pages of coded data Thematic analysis to condense the findings into seven domains


FINDINGS: FINDINGS The report presents finding by addressing 7 Sub Hypothesis However only the 5 most relevant finding are presented here Please see report for the details


Physical and Human Resources: Physical and Human Resources Do Indian FBOs have access to physical, financial and human capital which is and could be directed towards HIV? Yes


Physical Resources:: Physical Resources: FBOs provide >20% of Indian healthcare (Global Health Council, 2006). Five thousand Catholic institutions provide a remarkable 22% of health infrastructure (CHAI, 2006). 80% of healthcare in India is Private, and FBOs are largest private sector (CMAI). ?? Provide the majority of HIV treatment, prevention and care activities


Human resources: Human resources Staff Commitment: Recruit and Retain A ‘Calling’ to work in HIV care “for us Catholic Sisters serving the needy and PLWHA has become our life and purpose…our purpose is not marriage, having a family or making money” Reliable sources of HR Christian Medical College, St Johns Volunteerism- value for money!? FBOs rely on volunteerism and salary sacrifice


Physical/Human resources- Difficulties: Physical/Human resources- Difficulties Changing focus? Eg. Leprosy Funding Sustainability Changing funding sources Eg. Non-resident income ‘calling’ and ‘volunteering’ going out of fashion


Quality of Care: Quality of Care Is care for PLHIV firstly holistic and committed, and secondly of high clinical/medical quality? Mostly Yes!


Quality of Care: Quality of Care Holistic care: Loving- “We value each PLWHA as someone created in God’s image ….they’re real persons, not just cases or numbers….” Counselling- Strong in palliative care Multidisciplinary- Income generation, social etc Hospice care as an example of holistic care: FBO specialty…very little non-FBO hospice care. Quality of FBO care limited by poor ARV access: FBOs do everything apart from dispense ARVs Gov. has not used FBOs to distribute ARVs


Linkages- Downward to Community: Linkages- Downward to Community Can FBOs effectively engage numerous, diverse and marginalised community members in isolated areas? Yes!


Linkages- Downward to Community : Linkages- Downward to Community FBOs have Strong Community links Poor- 90% for poor Rural and isolated- 60-80% of services Groups Vulnerable to HIV Eg CSW, MSM, Dalits, truckers, ‘Coolies’ Common values- Indian Culture Vs Christian? Faith identification- Hinduism and Christainity Home based care-


Linkages: Linkages To support their response to HIV, FBOs have partnered vertically with national and international, government and non government agencies; and internally with Religious Umbrella Associations? Yes and No


Linkages- FBO to Church : Linkages- FBO to Church Church-FBO Disconnect Most HIV work is outside church Appropriate for India NOT Africa HIV is primarily a Health Issue WHO, Donors and Secular partners can easily engage para-church FBOs (Exceptions exist- Salvation, HOPE)


Linkages- Amongst FBOs in network/umbrella organisations: Linkages- Amongst FBOs in network/umbrella organisations Religious Umbrella Assoc. are a significant resource, facilitating: Training of member institutions Idea sharing and FBO linking Program Collaboration International linkages FBO visibility Governments, Donors and Policy makers need to link with Religious Umbrella Associations .


Catholic Umbrella Assoc doing HIV training for 20 separate HIV programs : Catholic Umbrella Assoc doing HIV training for 20 separate HIV programs


Linkages- FBO to Governments : Linkages- FBO to Governments Gov-FBO Link is weak: Mutual mistrust Changing NACO letter April Examples of good links Andhra Pradesh State Aids Committee and 10 bed grants to Catholics and others Government uses FBOs for HIV training


Gov. Funded Catholic Care and Support Centre in AP: Gov. Funded Catholic Care and Support Centre in AP


Technical/managerial Capacity: Technical/managerial Capacity Do Indian FBOs have administrative, management and leadership capacity to effectively organise, monitor and evaluate HIV programs? Smaller FBOs, No Large FBOs/ Umbrella Assoc, Yes


Technical/managerial Capacity: Technical/managerial Capacity Lacking in smaller organisations Salvation Army, WVI, CMAI, CHAI, HOPE good performers: Learn from donors (donor-capacity cycle) These FBOs link effectively with larger organisations Umbrella orgs. have significant capacity Can help overcome the technical/managerial deficiencies of smaller organisations MIs


Slide36: RECEIVE DONOR FUNDING APPLY FOR MORE FUNDING Assisted by financial management, IT, technical capacity, and experience in proposal writing GRANT FUNDS USED TO FILL GAPS- EG. Employ expert staff, and invest in IT GRANT REQUIREMENTS DEMAND IMPROVEMENT in M&E, financial processes, reporting, and management capacity _______________________________________________________________________________ FUNDING-CAPACITY CYCLE


Recommendations- Summary: Recommendations- Summary WHO HIV dept. should concentrate resources on HIV in India. WHO should implement guidelines/strategies to assist FBOs in India to maximise their contribution. WHO should further explore how to utilise FBOs links with communities for prevention, Rx and care. WHO should link with, utilise and increase the already significant managerial capacity of Umbrella orgs. WHO should undertake further studies to map the religious health assets in India and determine how best to partner (trainings, seedfunds etc) with such organisations


Recommendations ARVs: Recommendations ARVs ARVs- Governments/WHO/Partners need to partner closely with FBOs in India to achieve their treatment targets. IN HIGH PREVALENCE REMOTE AREAS ARV centres could increase the interval between required visits by linking to peripheral nodes (eg FBOs). Accredited nodes could collect blood for CD4 counts, monitor disease and need for ARVs, and even dispense ARVs (where qualified) The CD4 count could then be done locally by private laboratories or transported and done centrally.


Conclusion: Conclusion WHO, Governments, Donors and Policy Makers need to engage with Indian FBOs to help them go to scale. Why? NOT so FBOs can gain more prominence …BUT so HIV becomes less prominent as a cause of discrimination, suffering economic loss and death THIS COMMON PURPOSE MUST BE THE BOTTOM LINE