The Changing Face of Public Health Initiatives in Latin America

Most development operations in Latin America have faced shrinking budgets in recent years. In spite of this trend, Population Services International intensified its presence in the region in 2008, when it transferred its Latin America program office from Washington to Guatemala City. Deputy Regional Director Judith Heichelheim helps manage PSI's 200 Central America field staff and a regional public health portfolio that includes a rapidly expanding reproductive health program supported by European and U.S. donors. Heichelheim has more than 15 years of experience working in the public health sector, with a focus on sexual and reproductive health and sexually transmitted disease prevention. Prior to the deputy regional director position, she worked in PSI's Washington headquarters and in the field in Russia and Botswana. Devex spoke with Heichelheim about current public health funding trends in Latin America and PSI's operations in the region, including collaborations with local partners. What is PSI's mission? [We are a] a social marketing organization. We use private sector marketing techniques to make health products and services available to the most poor and vulnerable populations. Our approach can be applied to any health care issue. In this region, historically, we have focused on HIV. We've been expanding more into reproductive health and family planning. In Mexico, we are looking at obesity. There's an increasing burden of disease coming from chronic diseases. But it's hard to do because the development community is focused on infectious diseases. In Central America, we have a balance between HIV and reproductive health. Who are PSI's major donors in Latin America? There's U.S. government assistance. The majority that we exposed to is from USAID. CDC [Centers for Disease Control and Prevention] is very active here as well, [though] they don't provide as much funding. DOD [U.S. Defense Department] is active in the region, working with militaries doing HIV prevention. We are working with them in El Salvador, and we are starting some programs with them in the Caribbean. Another major donor for us is KfW, which is a German development bank. The Dutch are also a major donor for us. The Europeans got very interested in this region, partly because there was a perception that it was being neglected by the U.S. government. They've been very supportive to us. The Obama administration has said that Latin America was neglected before, and they want to pay more attention to it. We don't know how that's going to pan out … but it's exciting to hear the new administration paying attention to Latin America. The Spanish government is very strong in this region, but they tend to work with Spanish-registered organizations. We've been trying to work in partnership with them, but sometimes it takes a long time to develop a new relationship. The Global Fund [to Fight AIDS, Tuberculosis and Malaria] has programming here, so that's [also] a major source [of funding]. In some of the countries [in Latin America], the governments themselves do quite a bit. Mexico is a good example of that where the Mexican government has some tendering processes and the states do some contracts. We have actually implemented some of their programming. You see that more in South America. The governments here in Central America are so cash-poor, they rely on multilateral organizations to get support. IDB [Inter-American Development Bank] works a lot through the [Guatemalan] government. The World Bank is a big player in this region. CIDA [Canadian International Development Agency] has also been a player in some parts of the region. They have been supportive of us in the Caribbean … but they are not as active in Central America. What have been the public health funding trends in the region? [During the 2000s,] when you look at the rest of PSI's global programming, it grew exponentially in terms of revenue. But when you looked at us [Latin America], it was pretty flat … partly because of policies upheld by USAID - the ABC [abstinence, be faithful, use a condom] approach. Because we deal a lot with condoms - even though we deal with abstinence and being faithful - we were a target of people who didn't want us to be funded. The politics were stacked against us. I think that's maybe part of the reason that the Europeans came in as strongly as they did, because they realize that these were key pieces to have better health outcomes. KfW is very explicit about that. They think sexual and reproductive health go together and are very supportive [of] condom interventions and reproductive health targeted at younger people. The donor community has a rotating meeting that different heads of the development organizations go to discuss issues. [It's] not a formal structure. The Global Fund also has this country coordinating mechanism, where donors and NGOs and other interested parties are encouraged to participate. So, we go to those meetings, as does USAID and other donors. There's effort to make sure we are not duplicating efforts and that we are doing complimentary work. Are you seeing new funding trends with the new U.S. administration? It's hard to say. It's been sort of an interim year. There's a shift, at least in the U.S. government, to these partnership frameworks, where the U.S. government money gets coordinated at a country and regional level, and it's planned for rollout in 2011. Right now, we are sort of in this extension phase in all of our programming, and USAID is doing a lot of soul-searching and trying to come up with their own strategy on how they want to move forward in the region. One of the things that has been a trend across Latin America has been the graduation of countries from reproductive health support from the U.S. government and from UNFPA [United Nations Population Fund]. And the idea is that the countries then should be taking it on themselves. But the reality is that some of these countries don't have the money set aside for it. How does PSI partner with local organizations in Latin America? We are always looking for strong partnerships with other organizations, whether they are local or international. Sometimes, it's driven by the way funding is made available. In some situations, you have to name your partners in the proposal. So, once that's done, it's very hard to get other people involved. That's been a very clear way of operating under the Global Fund. On the other hand, with some programs, we have complete flexibility to figure that out. We may do a tendering process. We may just seek out who is in a certain village where we want to do something. We have different kinds of relationships with different organizations, depending on where they are. We are also reviewing that constantly. One of the things we are looking at now … is maybe looking at building capacity rather than just delivering on targets we have with a certain donor. It [also] depends a lot on donor requirements.