Are donors adequately funding faith groups in global health?

This was originally published by Global Health TV on Aug. 26, 2014.

Last November, at an event associated with the International Conference on Family Planning in Addis Ababa, Ethiopia, I was struck by a public comment from a representative of the U.S. Agency for International Development (USAID): “With almost 90% of people globally professing a faith, it doesn’t make sense to do family planning without the faith community.”

I was bowled over by this statement. I checked up on the claim, and found that, according to the Pew Research Center, 84% of the 2010 world population of 6.9 billion is considered “religiously affiliated.”

So the point was valid, and I would go even further: We in global development should be partnering more with the faith community in all areas of global health. After all, if the faith community can work on family planning – fraught with all of its social, cultural and religious baggage – it should also be able to work effectively on less controversial issues like malaria, diarrhea, water and sanitation. Especially in places like Africa where people have a high level of confidence in their religious institutions.

Ray Martin, who is stepping down as executive director of Christian Connections for International Health (CCIH) August 31 after 14 years on the job, knows as much as anyone about this issue (Full disclosure: I serve on the board of CCIH).

“While it is gratifying to me over a five-decade career in global health to observe that the development community has discovered faith-based organizations (FBOs), it still hasn’t sufficiently appreciated their potential — and the potential of religious leaders — to contribute to ambitious goals in global health and development.”

For years, donors like USAID have been funding large faith groups like World Vision and Catholic Relief Services. But in the last two decades, a unique and distinct category of organizations now called FBOs began to take shape.

“FBOs have a particular identity that they didn’t have in the past in the development community,” said Martin. “And some secular people appreciate that the faith aspect itself can add a special ingredient to the development dynamic, often positive, though not always, as in the early days of AIDS.”

He said that there is a growing willingness to take FBOs and religious leaders seriously but there is still a long way to go. Among major donors, he says, USAID is progressive in this respect and DFID [the UK’s Department for International Development] to some degree. United Nation agencies and the World Bank are less so although “the picture isn’t all bleak.”

Martin says that some people in the FBO world argue that fairness would dictate that donors provide considerably more resources to FBOs. So if FBOs in Africa provide 40% of health services, as they do in some countries, then FBOs should get 40% of the grants, or something close to it.

“I reject that argument,” said Martin. “I don’t think FBOs can make a compelling argument that they deserve any particular proportion of donor dollars. What I think we should argue is that the overall global health and development community need to embrace FBOs much more seriously than they have been willing to do thus far, if they have any serious hope of attaining the ambitious objectives they have articulated for the next generation.”

In fact, we do not know how much health care is delivered by FBOs in developing countries, and it varies greatly from country to country.

“This information is not systematic or comprehensive and much is difficult to find,” according to this excellent 2013 policy brief written by Katherine Marshall and Lynn Aylward of the World Faiths Development Dialogue and the Berkley Center for Religion, Peace & World Affairs at Georgetown University and the longer 2012 report which it summarizes. “Faith communities and organizations are important healthcare providers throughout Africa; while their exact market share is debated, it is large.”

The brief reports mixed findings on the amount of funding FBOs are receiving in global health.

While there are examples of collaboration between the global health community and FBOs, such as with UNICEF and UNFPA, FBOs “received only small shares of funding from some large health organizations. Estimates put the funds disbursed by the Global Fund to Fight AIDS, TB and Malaria directly to FBOs in its first eight funding rounds at only 3 percent.” On the other hand, large FBOs like World Vision and Catholic Relief Services receive significant amounts of USAID funding.

USAID and the World Bank both told me they do not quantify their funding to FBOs. However, both of them are trying to make it easier for FBOs to access their funding.

“We do not distinguish between funding for faith-based and secular organizations, but with a commitment to reaching the poorest of the poor, we recognize our faith-based partners are at the forefront of turning a new model of development into action, “said USAID Administrator Raj Shah.

“We want the best solutions to development challenges, wherever they exist,” said Adam Taylor, an ordained Baptist pastor who took over as the lead for the World Bank’s Faith-Based Initiative a year ago. “If they are developed by faith-based organizations, that’s great, but there’s no inherent advantage that FBOs have over secular organizations. It’s really all about impact.”

Taylor said that some development agencies used to have a bias against FBOs, viewing them as overly patriarchal and sectarian. “The good news is that a lot of those misgivings and fears have dissipated,” he said. “I think development institutions, including the World Bank, have turned the corner. It’s now much more about how do we partner in a way that’s going to reach the poorest and most marginalized, that’s going to stretch the dollar and have the most impact.”

USAID Administrator Shah says that since USAID’s founding more than 50 years ago, collaboration with faith and community organizations has been integral to USAID’s mission.

“Over the past decade, we have seen how this [faith-based] approach has delivered tremendous results,” said Shah. “We’ve helped immunize 440 million children; cut the rate of children dying from malaria in half; and nearly eliminated the transmission of HIV/AIDS from mothers to their children. These efforts have helped reduce child mortality by a half, and they would not have been possible without the tireless efforts of our faith-based partners.”

And Martin points out that with sustainability such a concern, one can make the point that religious institutions “will certainly continue regardless of economic growth, conflict or whatever, so investing in them will likely have a more enduring impact than investing in the ‘Beltway Bandit’ types of institutions that get so much of the donor dollars.”

But to forge truly effective donor-FBO partnerships, there must be change on both sides, said Martin:

“It is incumbent on the big donors who are talking about an AIDS-free generation  and eliminating preventable child death to revise their procurement mechanisms in order to reach faith- and community-based organizations. And FBOs will be taken more seriously only if we are more rigorous in our monitoring and evaluation, and more diligent about documenting our work."