Evidence for Faith Groups’ Activity and Contributions to HIV and Maternal Health

1. Evidence for Faith Groups’ Activity and Contributions to HIV and Maternal Health UNICEF

2. What is the JLI on Faith and Local Communities? Vision: • Robust evidence and smart communications to transform the quality, effectiveness, and impact of partnerships between faith groups and the development community • Collaborative learning platform that is cross sector, interfaith, cross discipline Christian Aid

3. Who: JLI F&LC Steering Committee

4. Collaborative platform focusing on evidence • What do policy makers and practitioners need to know? • What do we already know?Data on faith groups is limited and ‘silo-ed’ • How can what we know be better communicated? • Joint Learning Initiative Methodology (JLICA G Foster)

5. 4 JLI F&LC Learning Hubs Resilience:What is the impact of faith groups in promoting individual & community resilience in humanitarian situations? HIV & Maternal Health: What is the impact of faith groups on HIV and Maternal Health? Capacity Building: What are faith groups doing to strengthen the capacity of Local Faith Communities to respond to key issues in their communities? Immunization: How do and can faith groups contribution to the delivery of vaccines and immunizations?

6. Learning Hub:HIV and Maternal Health What is the impact of faith groups on HIV and Maternal Health?

7. HIV & Maternal Health: Hub Co-Chairs & Members OjusMedical Institute, AsavariHerwadkar Oxford University, Nadine Beckmann, Traidmission, Rob Kilpatrick, World YWCA, NyaradzaiGumbonzvanda, University of Glasgow,Julie Clague, UNFPA, Dawn Minott UNICEF, Julia Kim USAID, AfeefaSyeed, Utrecht University, Martha Fredericks, World Council of Churches, World Vision, Kate Eardley, Christo Greyling, Logy Murray & Jane Chege Unaffiliated: SigrunMogedal, Lucy Muriuki, Astrid Bochow, ManojKurian UNFPA, AzzaKaram (Co-Chair) World Vision ChristoGreyling ( Co-Chair) University of Glasgow Julie Clague (Co-Chair) CAFOD, Georgia Burford CMMB, Jeff Jordan, Sara Melillo Caritas Internationalis, Robert Vitillo Dutch Royal Tropical Institute, Korrie de Koning Emory University IFHP, SandraThurman IRHAP, Jill Olivier IRNARA,Rijk van Dijk Islamic Relief, Atallah Fitzgibbon, Najat El Hamri, & MamounAbuarqub Nordic Consulting Group, CatrineShroff

8. HIV and Maternal Health Evidence Scoping Report Two Stage Process Stage 1 – Mapping Existing Evidence Documenting the range of services, activities and impact assessments of the work of FBOs and local faith communities Stage 2 – Setting an agenda for further research; Policy and practice implications Based on findings of mapping exercise http://www.jliflc.com

9. Methodology of Evidence Mapping • Key research questions developed by 22 Hub members • Ann Smith and Jo Kaybryn, HIV and AIDS experts, engaged to collaborate with Learning Hub members in preparing an evidence scoping study and report • Evidence sourced from Hub members, networks and online searches • 11 Key informant interviews conducted • 200+ documents received • 75% of information was from unpublished “grey literature”

10. Mapping Evidence Research Questions Importance of focusing on HIV as a leading factor in maternal death particularly in countries or areas where HIV prevalence is highest (Foreman, et al., 2010) • What are the contributions to and impact of the work of faith groups in relation to HIV and AIDS and maternal health? • What are the challenges to faith groups, at local, national and international levels, in delivering on HIV and AIDS and maternal health?

11. FBO involvement in HIV and Maternal Health • FBOs’ involvement with HIV is diverse, often extensive outreach: • 1 in 5 HIV responses is faith-related (WHO 2004) • A comprehensive worldwide mapping of FBO HIV responses has not been undertaken and that there is little reliable national data (Keough, et al., 2007) • FBOs’ involvement with Maternal and Child Health services are common: • 90% FB health facilities in sub-Saharan Africa offer maternal and newborn services (Chand & Patterson 2007) • In Uganda, 50% of MCH provided through FBOs (USAID & Access 2007) • Services provided by FBOs in 6 African countries rated quality of care and satisfaction better than public sector services (Widmer et al 2011)

12. Key Findings re: FBO Contributions to HIV & MH • A number of information sources reviewed for this project cite PMTCT initiatives and/or training of traditional birth attendants (TBAs) as indicative of their involvement in HIV and maternal health, focussing on babies, women seem secondary (Melillo, 2012) • Publications indicate that FBO responses to HIV are holistic, addressing livelihoods, nutrition, stigma, gender equity, psychosocial and spiritual support, and advocacy concerns alongside health needs (Strategies for Hope, 2012) • Judgmental attitudes of some religious leaders and communities can increase stigma and discrimination (Courtney, 2011). • Women and poorest reached, but limited services with key populations including MSM, CSW, IDU and gender equality. • A tendency among some FBOs to use programmes as a means to proselytise (Gaul, et al., 2011).

13. Key Findings re FBO Contributions to HIV and MH • The Imam Training Academy of the Islamic Foundation of Bangladesh curriculum includes reproductive health, gender empowerment and HIV-related topics. 40,000 imams have been trained to deliver HIV prevention messages (Berkley, 2010) • The Catholic Bishops’ Conference of India supports 13 PMTCT centres through the Catholic Medical Mission Board (CMMB) In a pilot project in 7 rural hospitals a total of 438 (9.5%) of the expectant mothers were found to be HIV positive and received prophylaxis. No cases of mother-to-child transmission were reported (Vitillo, 2006). • Collaborating with the Indian Ministry of Health and other NGOs, from 2003-07, World Vision developed an effective method of delivering health messages to pregnant women in Uttar Pradesh, India. The number of births attended by TBAs increased from 0.3% to 30% in just 2 years. • IMA World Health responds to HIV and maternal health in DR Congo, South Sudan and Tanzania and provides voluntary counselling and testing, prevention of mother to child transmission, antenatal care, emergency obstetric care, community based training and awareness, community mobilization for prevention of HIV, training of Religious Leaders to promote mother and child health behaviour change through Sermon Guides, and Safe Motherhood Kits.

14. Key FBO Benefits and Barriers in HIV & MH Caution against stacking Benefits against Barriers Key benefits: • Moral motivation and shared values to poorest sectors, • Holistic perspective • Sustainable community engagement • FBOs can facilitate community mobilisation and buy-in for proposed initiatives (CHAN, 2012). They can also often engage members of their own religious community wary of or alienated by the approach taken by secular organisations (RaD, 2011) Internal and External Barriers: Internal: Poor documentation, less conformity to norms of public health strategies and prevention messages, slowness to collaborate, suspicion of secular agencies, judgementalism on sexuality, marriage, gender; hierarchical and male affecting women, reluctance to engage key HIV affected populations External: Little known outside FBOs, harder to capture value in VfM terms as less tangible, preconceptions and stereotyping, reduction of funding by multi/bilateral donors.

15. Key Findings • FBOs reported being in alignment with national guidelines e.g. National AIDS Programmes and working collaboratively with Ministry of Health. There is risk that some faith health institutions are of low quality due to lack of M and E, low awareness of HIV and limited programme activities by religious leaders and staff. • FBOs report holding governments to account through networks, but there was little information on their accountability to the communities they work in. • Lack of secure funding was cited most frequently regarding limitations to ensuring sustainability. • Significant numbers of volunteers are mobilised in FBOs. Drive for data collection is shown to overburden volunteers, divert them away from core work and risk losing them.

16. Opportunities and Challenges • Being community based, FBOs can ensure women’s voices are heard and inform responses to HIV and MH needs • FBOs can extend discourse around HIV and SRH to address women’s human rights • FBOs often have more holistic approach to care and support and can bridge MH between acute hospital phase and longer term, community based • FBOs are trusted influencers and can mobilize communities for health outcomes on a large scale • FBOs are well positioned to do advocacy, not just service provision through capturing data on stigma or abuse • FBOs should document and demonstrate effectiveness and impact

17. Recommendations Programme Practice (FBOs) Research (Academics and others) Identify tools for community qualitative data capturing Identify tools for capturing impact of holistic responses Document synergy between core values of faith and rights based approaches Develop tools to document social assets of FBO initiatives, added impact, volunteer base and VfM • Gather evidence, qualitative, quantitative and holistic • Put wellbeing of mothers as high as children and support women specific issues • Challenge stigma • Train faith leaders on HIV and Human Rights • Develop holistic, community led programmes

18. What you can do 1. Widely disseminate the Report (adapt this presentation !) 2. Share with JLI F&LC data and case studies on Faith Groups’ activities and contributions to HIV and Maternal Health 3. Look for opportunities to carry out research on the key questions raised in the Report 4. Join the JLI F&LC HIV AIDS and MH Hub, or the new Sexual Violence Hub

19. UNICEF more @ www.jliflc.com