BELIEVING IN HIV: The response of Christian Faith Based Organisations to HIV in India

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BELIEVING IN HIV The response of Christian
Faith Based Organisations to HIV in India

• Nathan.grills_at_sjc.ox.ac.uk

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• 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 epidemicBut success will
  require unprecedented willingness on the part of
  all actors in the global response to fulfil their
  potentialto embrace new ways of working with
  each other, and tosustain the response over the
  long term

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• 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.

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Presentation structure

• Background and Study Rationale
• India Update
• Study methodology and limits
• Findings
• Recommendations
• ???Questions and abuse

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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

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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?

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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

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High Prevalence States in India
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Doomsday Predictions!
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Study Sample and Limits
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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)

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Which Faith
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Why Christian?

• Methodologically
• Defining Hindu groups using FBO concept is
  difficult
• More valid to examine other faiths individually
• Pragmatically
• Practically

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(No Transcript)
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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

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HIV Prevelence/Field Visits
HIV prevalence at ANC sites lt 1.0 HIV
prevalence at ANC sites 1.5-2.0 HIV prevalence
at ANC sites 1.0-1.5 HIV prevalence at ANC sites
2.0-2.5 HIV prevalence at ANC sites 2.5-3.0 HIV
prevalence at ANC sites gt 3.0
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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

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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

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Physical and Human Resources

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

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Physical Resources

• FBOs provide gt20 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

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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 purposeour 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

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Physical/Human resources- Difficulties

• Changing focus?
• Eg. Leprosy
• Funding Sustainability
• Changing funding sources
• Eg. Non-resident income
• calling and volunteering going out of fashion

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(No Transcript)
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Quality of Care

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

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Quality of Care

• Holistic care
• Loving- We value each PLWHA as someone created
  in Gods image .theyre 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 specialtyvery 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

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Linkages- Downward to Community

• Can FBOs effectively engage numerous, diverse and
  marginalised community members in isolated areas?
• Yes!

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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-

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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

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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)

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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 .

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Catholic Umbrella Assoc doing HIV training for 20
separate HIV programs
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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

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Gov. Funded Catholic Care and Support Centre in AP
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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

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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

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__________________________________________________
_____________________________ FUNDING-CAPACITY
CYCLE
RECEIVE DONOR FUNDING
GRANT REQUIREMENTS DEMAND IMPROVEMENT in ME,
financial processes, reporting, and management
capacity
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
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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

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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.

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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