TUESDAY 25 JULY 2000
_________
Members present:
Mr Bowen Wells, in the Chair
Mr Tony Colman
Mr Piara S Khabra
Mr Andrew Robathan
Mr Andrew Rowe
Mr Tony Worthington
_________
MEMORANDUM SUBMITTED BY THE DEPARTMENT FOR INTERNATIONAL DEVELOPMENT
EXAMINATION OF WITNESSES
RT HON CLARE SHORT, a Member of the House, Secretary of State for
International Development, DR JULIAN LOB-LEVYT, Chief Health and
Population Adviser, MR BOB GROSE, HIV/AIDS Adviser, Health and
Population Department, and MR DAVID CLARKE, Department for
International Development, examined.
Chairman
652. May I welcome you once more, Secretary of State, to our
Committee, this time to consider the terribly important and tragic issues of
HIV/AIDS which we have been studying, not just taking written evidence for the
last four months but also because on each of our visits overseas HIV/AIDS has
impacted on everything we have seen in India, Bangladesh, Pakistan, and also
in the African countries we have visited, Kenya, Uganda, Rwanda, Mozambique,
South Africa, Malawi and Zambia. HIV/AIDS is a dominant problem in all of
those countries. So we feel that this is a really important developmental
issue. I understand that you have a short statement to make and I am sure
what you are going to do is answer a lot of the questions we have in mind
right at the beginning so one of the issues we want to ask you straightaway,
and perhaps you could include it or cover it during your initial statement,
is the situation you see on the outcome of the Durban Conference and the
Okinawa Statement, which of course was yesterday reported to the House by the
Prime Minister. No doubt you will tell us how optimistic or pessimistic you
are that the international community has an agreed effective strategy and
adequate funds to tackle the HIV/AIDS pandemic. Secretary of State?
(Clare Short) Thank you very much. I noted your interest. Andrew
Robathan made an important speech in the debate on Mozambique helicopters
indicating the scale of this and yet it was not discussed in a way that
immediate crises are. I want to make some very short introductory remarks.
The first point I want to make is that we at our very best are only part of
an international system. Sometimes when people get emotional about things
like AIDS they say, "What is the United Kingdom doing? Can the United Kingdom
do more?" as though we can do it, and we cannot. We are not the whole of the
international system. We do not operate everywhere. We can try to be a
leading force both in influencing the international system to operate better
and to do good work from which we learn and which drives forward our
understanding of what can be done. But sometimes the discussion is as though
a government like ours can lead the whole world effort, and of course we
cannot. The second thing is that within that, therefore, as well as trying
to strengthen international co-ordination and forward-thinking and
effectiveness of implementation, we have up to now worked on prevention. I
think up to now that has been right and we have then driven forward programmes
and efforts where we were strong and where we could get in and that has been
opportunistic because you depend on governments and responses to be able to
get beyond very small interventions. I think we are moving, as the document
presented to the Committee showed. I am sorry it is so long. I think it
could have been summarised and I apologise for that.
653. We have read it very carefully. It needed to be long.
(Clare Short) Okay, good.
Mr Rowe
654. Do not encourage them!
(Clare Short) We are widening and deepening our own efforts and
thinking. I do not apologise for it and I think it is right still to put a
massive effort into prevention. That saves lives, saves suffering, saves
economic cost but of course as ever more people get the illness, which has all
the economic consequences it has in the education sector and all the other
sectors, one needs to put more effort into care but still with a major effort
on prevention. The third thing I would say is that the major barrier to more
effective action in many countries, but particularly in Africa, where the
consequences are so great, has been the unwillingness of African governments
to move - with the great exception and the fine lead given by Uganda and
Senegal - so when people splash around numbers and say $2 billion is needed,
that sounds all very well and it sounds as though the only problem we have got
is that miserable, rich donors will not provide the money. That is just
untrue. We have not been able to spend or get in and when there are
governments that will not move, that are hiding, pretending, not facing it,
we cannot be a substitute for a government that will not take action. We can
find little interventions or NGO efforts but it is impossible for us, and that
has been a major problem for us across Africa and indeed other countries. As
with the debt campaign, a lot of campaigners talk as though all governments
in developing countries are good governments dedicated to their poor and
dedicated to the right policies, and that is not so. We need to mature this
debate to get more effective action and more effective pressure into the
international system. My final point, which is responding to your question,
and I might bring Julian in on it too, is we think that Durban has probably
been a turning point. The amount of energy and noise and attention to a
conference hosted in Africa and, in a funny kind of way, the controversy
around President Mbeki's position may have helped to make the noises louder
and the debate more vigorous, and there has been something of a sea change,
a mobilisation in Africa. South Africa itself has been neglectful to get to
this point without having had a really serious strategy, but is now moving.
Okinawa - how much that adds? The right things are said, as you would expect,
and it is important to get the right things said rather than the wrong things
said but implementation is also very important. A lot of the things that were
said at Okinawa were good. One of the things I am very pleased about in the
time we have been in Government is that the G7/8 have been forced to pay more
and more attention to development and that is a great achievement and I think
that will continue. You will know that there now is agreement that there will
be a report annually on progress against the international development targets
at G8. Otherwise it is just so disgusting that the world's richest countries
meet and talk only about their own affairs. I think we might have achieved
something of a sea change. Could I ask Julian to comment on what Okinawa
added.
Chairman
655. I ought to welcome Julian Lob-Levyt ---
(Clare Short) --- Who is the head of our Health and Population
Department.
656. And Bob Grose.
(Mr Grose) HIV Adviser.
(Clare Short) For his sins.
657. Are you still acting Head of Department?
(Mr Grose) I was acting Deputy Chief Adviser for a while, now full time,
permanent.
658. I am sure the Committee would like to thank you. I know that
the Secretary of State has apologised for the length of the submission but
this took a lot of effort and a lot of time and we are grateful for that and
for the fact that you responded to our questions by giving us a further
memorandum on questions that you were not able to answer at the time. The
Committee does appreciate the very hard work you put in. Perhaps you would
like to elaborate a bit on the outcome of Durban. I must say that I was
personally very disappointed that we had not got Mbeki on-line and back into
the mainstream and really promoting and leading in a way that he could do if
he chose to. That was my disappointment. I am very interested in what you
had to say, Secretary of State. You thought, strangely, it had promoted
discussion rather than suppressed it?
(Clare Short) That is the optimistic view of life which is the one I
like to take. There is no doubt that HIV causes AIDS. It is ridiculous to
question that. The science is absolutely clear. It is not helpful, although
of course there are special features of life where people are desperately
poor. For example, it spreads massively faster where there are untreated
sexually transmitted diseases and in populations where there has never been
or is very little availability of antibiotics. That is highly linked to
poverty and people's immune systems are weaker when they are badly fed and in
poor health. The opportunistic infections, the spread of TB, that is endemic
in poor populations. There is no doubt that the speed of spread and the
degrees of suffering and other infection are made massively worse by poverty.
That part of what he said is absolutely true.
659. That must be right.
(Clare Short) But to question whether HIV is the cause is just nonsense.
All I am saying is I think the controversy --- I bet if you go to South Africa
everyone is arguing about it in every township, and in a funny way that might
have helped and I think everybody knows that HIV is the cause. But that is
the optimistic view of life.
660. Dr Lob-Levyt?
(Dr Lob-Levyt) Specifically on Durban I think it was an extremely
successful conference, and having it in Africa for the first time was hugely
important. Within the conference room there was an enormous amount of
technical discussion as well which enabled a much clearer picture to be
established of what we can do, what we know works and what we know does not
work. The clear messages which came out which were brought back by many
colleagues showed great optimism about the renewed or clearer African
commitment to do something about this and that is where we should focus our
efforts and we can make a difference. The shining examples of Uganda and
Senegal and other countries in fact that are now beginning to show an impact
on the epidemic, were hugely positive messages that we could make a
difference. Like the Secretary of State, I think the debate generated was
reflected by the international coverage it got, not least from the United
Kingdom press which was enormous, much more than any other conference. That
now needs to be delivered but we are now more optimistic we can deliver.
(Clare Short) In the margins an initiative which we had to work with
SADC on a regional HIV/AIDS initiative was approved and so can go ahead. We
had our ministers there so that could be agreed.
661. You were there, Secretary of State?
(Clare Short) No, but we had officials there. Okinawa?
(Dr Lob-Levyt) We did not have anybody at Okinawa.
(Clare Short) But we worked on the text and so on. Because the second
part of Bowen's question was what was the impact of what was said at Okinawa
and how helpful and useful is that?
(Dr Lob-Levyt) We were very heavily engaged in Okinawa in preparing the
brief so the United Kingdom inputs were largely included in the final
Communiqu‚. It is very clear that it raises HIV as being the challenge to
development alongside TB and malaria, specifically calling for a conference
after Okinawa to look at how we can mobilise the new resources that are coming
from the private sector, from donors, with increased international commitment,
and how we can translate that into more effective action, and to see which
agencies have the best chance to deliver this new higher agenda, and to report
back to G8 next year on the progress that can be made. The setting of
specific targets for HIV was merely a reiteration of the international
development target that we have on HIV, but to have it effected in the
Communiqu‚ is hugely important, as it is for those on TB and malaria.
662. First of all, on the Durban meeting, are you really saying
that the optimism arises because the Conference realised that you could
actually manage this disease, this infection and that there were things that
could be done to mitigate, but of course not cure yet, the HIV/AIDS problem?
Was that the source of the optimism, because I think it would sound to the
general public very strange that there was optimism coming out of Durban given
the figures presented at Durban on the level of infection in Africa. Some of
the evidence given to this Committee suggests that live births in Botswana in
some of the clinics attended by women are at the horrendous figure of 70 per
cent being HIV positive. That would be a depressing figure to the general
public but you are now saying we are very optimistic after Durban and I think
one needs to explain why.
(Clare Short) Even within a country the levels of infection vary by area
and region, so it will be particular communities with risk behaviour and so
on rather than the whole of Botswana. Let us be clear, we were already clear
about the horrendous figures, the horrendous suffering and the horrendous
economic consequences, the massive reversal of development gains, measured
most clearly in the loss of life expectancy. These are tragedies piled upon
tragedies for human beings and economically. It is desperately destructive.
We knew the scale of the challenge already. We as a Department have been
frustrated in our work in some countries by the unwillingness of governments
in Africa and in other countries to face up to the challenge and what they
need to do. Governments were moving anyway. President Moi had moved and so
on and Zambia was moving. We have had some movement recently and Durban
catalysed and moved forward the willingness to face it and the willingness to
take the action from the agenda that we know is the best action to take.
Obviously we are not being optimistic about the scale, the challenge, the
suffering and the economic loss.
(Mr Grose) I would just make one point about ex-President Mandela's
statement at the end of the Conference which really lifted the tone of the
meeting tremendously ---
663. He has been very brave on this issue the whole time.
(Mr Grose) He set out an agenda we would all sign up to. He summarised
the real priorities. As an advocacy event, that encapsulated the main
messages for other African leaders.
(Clare Short) But even under President Mandela when he was the
President, although he did stand up and talk about HIV, South Africa did not
have a clear, forward-looking programme even with someone who has been brave
about talking about it like President Mandela. We have got to get governments
to take it so seriously that they start taking the actions that are needed
right across their countries.
664. Exactly. Okinawa is important, is it not, because as you
said, Secretary of State, Britain alone cannot do this. It has got to be a
co-ordinated world programme, involving all those countries suffering from
HIV/AIDS, which is the whole world really. Were you not disappointed that we
did not have a specific sum of money agreed in Okinawa to combat HIV/AIDS?
(Clare Short) No, I was not, because this is the great ruse of
international development conferences, in my view. "We need more primary
education. Let's have a fund." "What's the fashion this week? Deserts.
Let's have a fund." "Trees this year. Let's have a fund." Of course that
is how it goes and then everyone can go away, it can be in the newspapers and
everyone can pretend we have done trees, deserts, HIV, or whatever it is this
year. They are notional funds and if there is not a follow through and if
programmes cannot be driven forward --- In our own Department the restraint
has not been the unwillingness of the Department to spend more on HIV/AIDS;
it is being able to find governments where you can spend effectively and
really help. So, no, I am not and I really get fed up with demands for a fund
as a cheapskate way of pretending action is being taken. The same happened
at Dakar with education. The restraint on driving forward the commitment to
primary education in the poorest countries in the world is not just
availability of funds. Many, many developing countries prioritise higher
education and spend far more money on it and have little motivation about
primary education for poor children. A notional fund that might tie up money
of ours which is not spent effectively does not help anyone. It is gesture
stuff and I am rather against things like that.
665. The Okinawa Communiqu‚ linked the fight against HIV with that
against TB and malaria, which are opportunistic diseases, as we call them,
related to HIV/AIDS. In what sense will there be a combined effort against
these three diseases?
(Clare Short) The growth of the incidence of TB is linked to the HIV
pandemic and, as I said earlier, poor populations where it is endemic, and it
is amongst many poor populations in many parts of the world, if HIV is there,
TB will flare up, and that needs to be treated just for the quality of life
for those people and I suppose the risk of more people being infected. On top
of that we have got this multi drug resistant TB spreading in the world. It
is very prevalent in jails in Russia. That is a danger to the world. It is
very expensive and difficult to treat. There is a case for doing something
about TB separately. It is linked to HIV but there is that threat from TB.
On malaria, it still kills a million people a year, mostly in Africa, mostly
children, separately from HIV. Before the HIV epidemic or in countries where
it is not very high, there is massive suffering, loss of life, use of health
facilities. You will find lots of people in hospitals with the consequences
of malaria. We now understand very much more clearly than we used to that it
is the poor that get sick, but sickness in a family creates poverty. Families
with a sick family member will borrow or sell their animals to buy drugs and
it drives people back into poverty who have been working together to get
themselves up. There is a need to attend to malaria, again because of human
suffering, again because it is spreading in the world. I do not think there
is a malaria link to HIV, is there?
(Mr Grose) No.
(Clare Short) There is this Roll Back Malaria initiative. We could do
better on malaria if we applied systematically the knowledge we have got. For
example, the use of insecticide-dipped bed nets can massively reduce the
incidence of malaria and therefore the loss of human life and the sickness and
the economic consequences. There is a separate initiative to Roll Back
Malaria. On top of that we need to work with the drug companies to get
appropriate drugs because of course if the drugs are badly used they become
irrelevant. There is an overlap with TB and HIV. Malaria is separate but
that is also very important. This multi drug resistant TB is a big danger to
the people who suffer from it, and also internationally.
Mr Rowe
666. I just wanted to ask does DFID, for example, contribute to
the work that is being done to genetically modify the mosquito, for instance?
Is that an appropriate thing for DFID to do or do you feel it belongs to some
other part of government like the Health Department or something?
(Clare Short) No, we think that on appropriate drugs for some of these
illnesses --- Given that pharmaceutical companies will not invest in a lot of
research for markets that are so poor they will not get a rate of return, and
yet the best science we have got in the world is in the private sector (we
have got some very good people in the public sector but nonetheless the
capacity of pharmaceutical companies is so great) we are very interested, with
the World Bank and the World Health Organisation, in creating partnerships to
get the best of the science taken forward in a way that left to itself the
market would not do. We need the knowledge of the private sector to be part
of the research and to create partnerships, to develop the best medicines and
remedies, like a vaccine against HIV for Africa which the market would bring.
It is a different strain of HIV so if you leave it to research done in Europe
and North America we will not get a vaccine for Africa. We are very
interested in working in that way. Julian might want to add something. It
is a new way of working but it is very important. If we leave it to the
private sector it will not deal with the diseases in poor countries because
the market will not get the return. If we do not engage with the private
sector we will lose access to some of the best and most advanced scientific
thinking and research. We need to bring them together and leverage a
partnership way of working that produces the drugs and the remedies for poor
countries that otherwise will not be developed.
667. Thank you.
(Dr Lob-Levyt) Specifically on malaria we support the Medicines For
Malaria venture which is a private venture capital company, a partnership
between the public and private sectors managed originally by the WHO, now set
up as a separate institution itself. That is funding exactly that kind of
work trying to find new drugs and new technology. Specifically, the mosquito
genetic engineering you talk about is an example of that. We have not funded
that particular piece of research but we are funding many other aspects of
basic research where we think the use of public funds in a private partnership
can really get people to focus on the needs of developing countries.
Chairman: Andrew Robathan, you were going to lead us on the DFID
expenditure programme but you want to preface it with another question.
Mr Robathan
668. Secretary of State, as you know, I feel that you and your
Department have taken a very sensible, realistic and responsible attitude to
AIDS. It is not Britain that should be alone responsible; I entirely agree
with that. You have shown a very responsible attitude. I do not disagree
with anything you have said in your opening statement, which is a bit of a
difficult position to find myself in. Following Okinawa you particularly
mentioned that we should not be over-optimistic about this. Do you think that
the targets that were set were over-optimistic? I know the AIDS target and
possibly the TB and malaria targets were previously set by the UN but is not
the target of reducing TB deaths by 50 per cent in ten years completely out
of kilter with the graph which is pretty much on the up dramatically? I have
not got it in front of me.
(Clare Short) Julian will come in and talk with medical expertise. I
would say on targets that basically the international development effort has
been full of rhetoric about poverty and very unfocused and not output driven
and not measuring its effectiveness. As you know, we as a Government and
since the White Paper have tried to drive targets. There is always a danger
that everyone wants to proliferate targets and that will not do because they
have got to be serious targets that we can get the whole international system
to co-ordinate around. It focuses the effort and you can measure the
effectiveness. That is why we are keen on targets. We are getting some
increase in the efficiency in the international development system because of
targets and it could massively improve before we got any more resources into
it. The AIDS target was Cairo plus five and was a 25 per cent reduction in
the rate of infections for young people. I think that was aimed at focusing
on effort that was not going on. More than half of new infections are young
people and more than half are young women, and that is not where people's
minds are and there needs to be a shift, lots of educational effort and self-
protection. Again on TB I am sure we can be more effective by being more
focused. The realisticness or otherwise of the target, I will ask Julian to
comment on.
(Dr Lob-Levyt) These targets come from the WHO who have looked at this
with the current technologies that we have and the kind of resources that
might be required to do that. We believe that target is achievable.
(Clare Short) WHO, as you probably know, has not been a particularly
effective organisation for some considerable time. Gro Bruntland (?) is a
great new leadership for it and our own dear David Navarro, who used to do
Julian's job, is there as Chief of Staff. It is an organisation that is
improving the quality of its leadership. If people of that quality tell us
that these are useful targets, we would be inclined to support them.
669. Specifically on the HIV infection target, looking at Uganda,
which has been held up at least twice this morning as the best example we
have, started their HIV programme in 1987. Have they managed to reduce
infections by that amount?
(Clare Short) I asked Bob Grose that question in preparation for this
meeting. On this question of how much you can achieve if you really campaign,
the Uganda example is very important. If Bob can respond to your question.
(Mr Grose) They have cut their levels of HIV infection from about 14 per
cent to about eight per cent. They have not quite got to the 50 per cent
target yet.
670. But nevertheless they are getting towards it?
(Mr Grose) They are heading in the right direction.
671. That is encouraging. You mentioned how important political
leadership was. I do not criticise you, Secretary of State, in any shape or
form, but were you in the Chamber yesterday to hear the Prime Minister's
statement?
(Clare Short) No, I am afraid I was not.
672. I think it is very worrying that the Prime Minister's
statement, written by his office, said that he supported "concrete
quantitative targets for reducing deaths from AIDS, malaria and tuberculosis
by 25 to 50 per cent ..." I think we would all agree that to try and reduce
deaths by AIDS by 25 per cent in the next ten years, given the lead time, the
incubation period, and so on, is probably not what we are talking about and
not within the Communiqu‚. I think it is rather distressing. Do you think
the Prime Minister understands the complexities of the AIDS situation?
(Clare Short) He has taken a lot of interest, since his first visit to
South Africa, in the question of HIV and AIDS. Of course, as you know, the
quality of our government system might not be perfect but we are reasonably
joined up. We do not have Prime Ministers wandering around the world
unbriefed. I know Julian was highly involved in the targets prepared for
Okinawa. Presumably he quoted in his statement the target agreed in the
statement from the summit, or not?
673. No is the answer. He came up with a new target which is not
the target. Furthermore, I do not think this target is meetable.
(Clare Short) We had a seminar on competition policy and the
contribution it could make to countries more rapidly reducing poverty, so I
was not there. I will look into that and write to the Committee and consult
with Number 10.
674. You might write to the Prime Minister as well.
(Clare Short) I cannot comment because I do not know what was said.
Chairman: I think we should get on.
Mr Robathan
675. It is a very important question about political leadership.
(Clare Short) Can I add that all of us have sometimes slipped in what
we have said in the Chamber.
676. Not when you have got a written statement in front of you.
(Clare Short) No, but I will find out exactly what was said, what should
have been said.
Chairman: I do not want to encourage the prolongation of this
discussion mainly because, Secretary of State, you have only got an hour
longer to spend with us.
Mr Robathan
677. I will move on from that. I think I have made my point. The
second point is a very important one about the Communiqu‚ from Okinawa.
Something we have been discussing the whole time is about how AIDS is a
developmental issue, I think the biggest developmental issue facing certainly
sub-Saharan Africa and possibly the world. It is not just a health issue, and
I find it distressing that in the Okinawa Communiqu‚ AIDS comes under health.
Would you like to comment on that?
(Clare Short) I agree with your preliminary remarks. Most people are
drawn to it first and see it as health, but if you only see it as health we
will not be as effective as we should be in prevention. I have just been to
Russia a couple of weeks ago. There is a massive spread in the use of drugs
amongst young people, sharing needles, and serious HIV spread. The actions
that need to be taken are not just in the health sector to deal with that, so
you are right but I think the whole world has had a mind lag here. It first
presents itself as a health problem, so people think health, but if you
confine yourself to interventions in the health sector you are not acting as
powerfully as you should to prevent and indeed to try to attend to the
economic consequences in terms of family poverty and so on that flow from
people dying.
678. I think to stay in order with the Chair I had better move on
to the particular questions I was asked to ask which relate to the expenditure
of your Department, and this ties very much in with the statement yesterday
when we wanted to know what the specific details of expenditure related to
HIV/AIDS were. Both Ronnie Campbell and Harry Cohen asked that question. How
would you define HIV/AIDS-related expenditure because, as we have said, it is
not just health, and to what extent should donors simply increase sectoral
programmes in response to HIV/AIDS, and to what extent should they establish
AIDS-specific programmes both in prevention and impact mitigation?
(Clare Short) We were asked to prepare these figures. Our spend has
increased from œ15 million in 1992/93 to œ55 million in 1999-2000 and this
includes sexual and reproductive health and non-health activities in which
HIV/AIDS is flagged as a significant element, for example, in education and
prevention and so on. But the implication of your question is absolutely
right. The more we mainstream our efforts the less we will be able to measure
separately because it will be mainstreamed right through our programme. It
is like gender. If you have separate money for spending on women's equality
you can measure it, but if you do the better work of taking that perspective
right through all your programmes, measuring your exact spend and
disentangling the bit that is relevant to HIV/AIDS as opposed to more broadly
education or improving primary health care, it becomes difficult. I will ask,
is it Bob who should come in on this? We have quite a sophisticated way of
trying to mark and track the way our spend goes. The more we do good work and
mainstream it, the less easy it is going to be to just have separate crude
figures for spending on HIV/AIDS, you are absolutely right. Bob?
(Mr Grose) Coming back to your two questions, if I have understood them
correctly. How much should there be sectoral spending and how much should
there be HIV specific spending? I think there needs to be both.
679. A politicians answer.
(Mr Grose) As we mainstream more then people who control budgets for
education or rural livelihood protection or transport or a whole range of
things will be spending money on HIV. That goes back to what the Secretary
of State was saying about the difficulty of identifying that always as HIV
money. At the same time we do need to be spending money on HIV prevention,
that is the first priority, and increasingly on aspects of care. That will
be easily identifiable as HIV specific money. Having said that, some of the
money that goes into care, in fact, will go into health sector or health
service strengthening and then that becomes difficult to identify necessarily
as HIV specific. Even some of the money that goes into improving people's
access to care when they become ill from HIV would not necessarily be
identifiable as HIV specific. That is why the answer is both.
(Clare Short) If you take reproductive health care, which is one of our
objectives anyway, and earlier treatment of sexually transmitted diseases,
that is important in its own right but also massively slows the spread. If
the Committee comes back to this, we will just be very straight with you about
our spending and how we are tracking it. I do want to flag the fact that the
more we mainstream, the more difficult it is going to be to just very
accurately, separately, account for just HIV/AIDS spending.
Chairman
680. Can I intervene here because the evidence taken by the
Committee from the Department when Dr Lob-Levyt was with us giving evidence,
which was only less than two months ago, the figure given to us was that we
would be spending œ20 to 30 million over the next three years per annum.
(Clare Short) Is that commitment or spend?
681. œ100 million in total over three years was the evidence given
to us. Your figure today suggests œ50 million I think.
(Clare Short) 55 in 1999/2000.
682. Yes.
(Clare Short) I will bring Julian in, and I know they have been doing
work on this, but we have always got commitment figures and spend figures.
They are always different.
683. I do not want to quibble about the figures too much because,
as you have just described, you can ascribe parts of all sorts of programmes,
quite rightly, to this. I am not saying you are fiddling the figures but it
is difficult to know what to include, what not to and so on What we are
trying to get at as a Committee is basically the question that this figure of
spend is actually far too low. We were surprised how low it was. We wondered
whether you would share our surprise at this figure and whether you have plans
to increase it?
(Clare Short) No. As I said earlier, our problem has been willing
governments, not our willingness to spend.
684. Right.
(Clare Short) We have been pushing and trying wherever we are strong,
wherever we could get in, to run programmes and do the best.
685. Yes.
(Clare Short) Where governments will not move, to be able to get to
scale is then very difficult. You can fund the odd little NGO and that is
better than nothing but it is not the kind of care. Can I ask Julian to
clarify.
686. If you want to clarify the figures, I think we should just
leave that because you said in fact you were in the process of refining them
yourselves. If you could write to us about the way in which you have made them
up and what they currently are so we can be absolutely accurate as to what
your evidence is.
(Clare Short) We are not trying to obfuscate or hide in any way.
687. No, no.
(Clare Short) It is this problem of how do you count good programmes for
treatment of sexually transmitted diseases, etc., and the availability of
condoms. We subsidise a lot of condoms that go to Africa and so on. We were
doing reproductive health care work anyway. It is all those kinds of
questions.
688. I think the Committee very well understands the difficulty.
It is a matter of technically getting down to how you made up the figures and
what they are. If that could be given to us in written form I think that is
the best thing to do.
(Clare Short) Okay.
Mr Rowe
689. A supplementary to that. For example - and one or two of our
witnesses have told us how important this would be - if DFID decided that one
of the most useful things it could do would be to enhance the income of
families caring for AIDS victims, quite apart from anything else to stop the
children being taken out of school in order to earn money, for example, would
that be HIV/AIDS expenditure in your budget again?
(Clare Short) We are doing more and more on the livelihood enhancements.
With the rural poor, who are still the poorest of the world, not so much doing
a maize programme or a fishing programme but trying to build around people's
lives because rural people tend to do a bit of this and a bit of that. They
might have a market stall and do a bit of fishing and the women folk might
make clothing and so on. We have been trying to do more and more of that rural
livelihood, building up the income levels of poor families. In families
afflicted by people dying or being sick that is highly relevant but it is not
just an HIV programme. As I understand we have this prism marker system in the
Department, how we measure, and we would make a judgment attributing if we do
a new livelihoods programme in, say, Zambia, we would make a judgment about
how much of that is helping families affected by HIV and mark it in our
statistical system. That is the best we can do. In the end you cannot totally
disentangle because you want to help families whether they have HIV/AIDS or
not. That is how we do it, we could explain it more fully in this letter.
Chairman: Yes, we do know about prisms but that is an important point.
Mr Robathan
690. Could you explain to the Committee how the money you are
spending this year on HIV/AIDS is broken down both regionally and in terms of
type of activity? For instance, is it still overwhelmingly devoted to
prevention?
(Clare Short) I think the answer is yes but I cannot really answer that.
(Mr Grose) The answer is that the overwhelming amount is still for
prevention.
(Clare Short) As I say, I do not apologise for that. We must do more
about care. Prevention is still the big thing to pursue.
691. Regionally?
(Mr Grose) We would have to come back to you on that.
Chairman: If we can get that in a statistical answer. Tony
Worthington, could you continue on this.
Mr Worthington
692. Can you talk to us a little bit about, I suppose, ideal
projects or activities over the next few years? What is it that you are
looking for? What is an ideal focus of concern and activity?
(Clare Short) I think an ideal is that countries have explicit and clear
strategies and that the international community is collaborating behind that,
so the prevention, education, supplies, treatment of sexually transmitted
diseases, support for orphans. The number of orphans and the lives they are
leading is a real worry, coherently so. The ideal is not separate, fine UK
programmes, it is countries leading and us collaborating. That is where we
want to be.
693. What are the characteristics of the good prevention
programme?
(Mr Grose) The first thing I would say is that they must be targeted on
people who have the highest levels of risk of either transmitting or acquiring
HIV infection. How you define those groups varies hugely from country to
country and within countries. The group that is most often cited is commercial
sex workers and their clients. Now, in some countries you might find that
there are groups of males who have sex with males, all have to be reached and
take part. In some countries you might find there are injecting drug users who
also need to be reached and take part in programmes. In general even where
there are very high levels of prevalence, as in some of the African countries,
targeting is still important, it is just that the target is much bigger. It
is particularly important in those countries to be working with young people
and enabling young people to reduce the risks they take. Young people are
important in all the countries but they are particularly important in
countries with high levels of prevalence.
694. Can I tell you an impression I have. The Secretary of State
was talking about a mind lag we have had in this area with regard to NGOs. I
have the impression that the NGOs have had a mind lag on AIDS related
initiatives in that you have on the one hand the very big Oxfams, Save the
Children and so on, and then you have specialist reproductive health NGOs,
such as Marie Stopes, Population Concern, and that neither have really
adjusted to the AIDS environment in terms of their project. Would you feel
that was true?
(Dr Lob-Levyt) I would say that many NGOs have contributed substantially
on the advocacy side, championing the rights of women in particular, which has
been very important, and have contributed some important projects. I think
what is more important is to scale up this kind of intervention, to have the
governments in the lead and for NGOs to work to support those governments and
to move governments into the mindset of thinking where they should take
ownership/leadership and drive the partnerships which are going to make a
difference. I think moving away from small NGO projects with limited impact
and scaling up rapidly, that is where the NGO should be thinking to facilitate
that process.
(Clare Short) That is a real challenge to their way of working. This
opportunistic, getting in, helping early stages, challenging people to face
up to it is a very good act and then when we move to the next stage that is
the challenge to ways of working and thinking.
(Mr Grose) If I could add that also I think NGOs are facing the same
kinds of challenges as the larger agencies, and that is a shift from HIV as
mainly health problems to HIV impact, and that is a major development problem.
They need to face the challenge, as we all are, of making sure they are
building the response to HIV impact.
Chairman
695. Are there examples, other than Uganda, of countries scaling
up their programmes in HIV/AIDS?
(Clare Short) Thailand, where its commercial sex workers went for a
major push on condom use successfully. Senegal is the other country that I
know a lot about which went for public education and has not seen the growth
of prevalence.
696. Outside Uganda, Thailand and Senegal, are there any new ones?
(Clare Short) Zambia?
(Dr Lob-Levyt) Yes, we are beginning to see the same kind of increased
fiscal commitment and spending in Zambia and also in Tanzania.
(Mr Grose) Brazil.
Mr Worthington
697. Getting one's mind around this, what is the proper response
of DFID, what is the proper response of a development department? I can see
that your work on prevention is crucial, is absolutely fundamental. Where I
have difficulty is where it gets into care and the provision of drugs. It is
a bit like you are saying the problem with education is that the elite in a
country want to put all the money into higher education and neglect primary
education. Is there not a danger that development budgets will get skewed by
AIDS as the demand comes for more and more high expenditure care and that is
for someone else to do rather than for a development department? Does that
make any sense?
(Clare Short) It does indeed. Just as the same problem that there is
with education, there is with health care. If you look at a lot of developing
countries, of the health care budget, which is usually inadequate, a major
part is spent in hospitals in the capitals and in the cities and very little
on a primary health care system reaching across the country. This is very
important for treatment of basic illnesses, immunisation of children, access
to reproductive health care and so on. We have that same battle, it is elite
versus poor people. It is a very big battle for us in all our programmes.
On HIV/AIDS the French Government and a lot of American AIDS lobbyists are
making this demand for antiretroviral drugs to be made available and saying
"This is an absolute moral issue. It is prolonging life in developed
countries. If they are not available this is unjust". These drugs are
extremely expensive even after the drug companies have said they will supply
them at cost. They are something like three dollars a day. There are a lot of
countries in Africa that spend less than ten dollars a head a year on health
care. That is my biggest worry, that the fashion will be access to
antiretrovirals. We have not got primary health care, we are not even reaching
people. They have not got enough food, soap, water, very, very fundamental
care. Budgets could be sucked into a kind of fashionable campaign to make
antiretrovirals available which again would necessarily be in the cities and
would not reach all the people. I think there is a danger there. I think if
we stick, as a Department, with our poverty objectives and we mean by care,
primary health care for all, get to scale, include all, focus on the poor,
care for orphans, we are going to have an awful lot of children growing up in
households without enough food who are going to be stunted. Their education
is endangered. That is a priority for our Department, but if we, as a
department, protect our focus on the poor it keeps us right. It is when
fashion pulls them in other directions that - and I think this is a danger for
the international system and for many countries - their spend will be focused
on getting antiretroviral drugs to the elite and the poor old poor will just
be left out.
698. Can I stick with the prevention aspect and ask what you think
our priorities are in terms of prevention activity? One of the areas, just
to throw in, is that we receive continuing reports that, not just DFID, but
the world community, cannot get a basic issue like the issue of prevention.
There just is not an adequate supply through the Sub-Saharan Africa. Why is
it that we cannot get - not only DFID, but the world community - a basic issue
like that sorted out within that issue of prevention? Do you think we have
our priorities right in terms of investment or, for example, in terms of
microbicides, or in terms of vaccines, or generally?
(Clare Short) Could I say, Chairman, I have to go to a Cabinet Committee
at 12.00.
Chairman
699. We have been notified that you have to leave at about 12.35.
(Clare Short) That is fine, yes. Sorry, I am wrong. I am going to ask
Bob to come in on prevention. On condoms we are very interested in social
marketing and helping to provide supplies, but again you cannot just throw
money around, it has to be good procurement and supply systems, and I think
that is where the restraint lies. Again, it is gesture spending when you have
not got systems that take through the supplies to people who need them, you
will suffer, and then you get into corruption and all sorts of other problems.
On the point of microbicides and the vaccine, we have been backing work. We
were the first Government to contribute to the vaccine research and we are
very interested in that and determined to support it. A microbicide that
works has not been found yet, but we will continue. Would you like to comment
on the condoms and prevention in general and whether we are putting our
efforts in the right places?
(Mr Grose) As a general statement first, I think we are putting our
priorities in the right places and that is condoms and STD treatment.
(Clare Short) Can I just say that STD treatment is massively important.
It fantastically slows the spread.
(Mr Grose) The condoms and STD treatment is work that has been going on
for a long time, but there needs to be more done, it needs to be intensified.
The vaccines and the microbicides will not become available until sometime in
the future, so they are a longer-term strategy. It is a bit difficult to say
what is more important. What is more urgent is getting more condoms out and
getting more access for people to STD treatment.
700. What is the---
(Mr Grose) Some of it is simply that they are not in the right places at
the right time because of lack of cash, but more often - we have done a bit
of looking at this over the last week and getting feed back from UNAIDS and
from our people in our own field - the problem is in logistics management.
Governments are not forecasting their needs accurately. Several of the
countries in the southern cone of Sub-Sahara Africa do not have condom
logistics officers in their national AIDS programmes. Some of the external
agencies that are supporting them are providing those logistics officers. We
are hoping that that part of it will improve, but as the Secretary of State
was saying, it is not just a matter of shortage of product, it is also a
matter of planning.
(Clare Short) Often it is organisation and will, and its system. Poor
countries have systems that just do not work and there are often people
running their systems who have ulterior motives and are not focused on making
them work. If you inject supplies of condoms into a system that will not
deliver them across the country---
701. Is this saying that any reasonably functioning Department of
Health can get the condoms?
(Mr Grose) I think they can.
702. So there is no real supply problem, it is an organisation
problem?
(Mr Grose) We are not aware that there is a global shortage of condoms,
it is more a factor of getting them to the right place at the right time.
(Dr Lob-Levyt) There are enormous problems with forecasting needs of
individual companies getting them and bringing them in, and that is largely
a systems issue. There are stock-outs from time to time. Certainly we need
to get that organised, but globally there are sufficient resources and
sufficient condoms.
(Clare Short) If we got a big improvement then supplies would have to
be increased and we might have the other problem, but it would be a good
problem to have.
(Mr Grose) If I can just add, the concern is not only a matter of
getting them into the country, it is a matter of getting them to the right
people at the right time. We do know where there are social marketing
programmes, they are not necessarily always available and of the highest
behaviour, but there are condoms getting to the right places.
(Clare Short) That is the high risk population of course, but spread
that out into the main population.
Chairman: Can we move on to care and health planning, and we have been
talking about antiretrovirals?
Mr Khabra
703. I am going to ask a straightforward question. Given the
scarce resources that are available to developing country health services and
the many aspects to the ill health of the poor, resulting in some cases in TB
and malaria, in your opinion what priorities for expenditure should be adopted
by health services in countries of high incidence of HIV/AIDS?
(Clare Short) I believe that all poor countries need a universal primary
health care system, and for something like as little as $12 a head a year you
can get a basic primary health care system reaching all, then you have a
mechanism for immunising children, giving people access to reproductive health
care, proper supervision of TB treatments and malaria advice. Then you have
a network. In most countries we have not got that and it is not the property
of the Government to get a universal primary health care system. That is our
passion in health and our work. You need them, it is not just the odd clinic
here and there, you have to get a Ministry of Health that is determined to
have that outcome that will reform itself and its budgets, and train its
people and get a service right across the country. I think there is no
divergence then between the priority for better HIV care and reaching people.
The other health care issue is to get a primary health care system right
across the country. We have an enormous battle to get that. It is elites
versus poor again.
704. Would you agree that with a country like India with a massive
population that a primary health care service that is universally available
to people is impossible?
(Clare Short) No, I do not agree. I think what we are seeing in India
is a massive divergence state to state with the quality of development and
service provision, and I think India has enough capacity and highly educated
and capable people that with real will it could have primary health care
across the nation. I think it is a matter of will.
Chairman
705. Is it true that over 70 per cent of India's health care is
provided by the private sector?
(Dr Lob-Levyt) That is correct, I think that is the idea of the future.
When we need to look at health sectors we are not just looking at the
provision of health care. There is a rapid expansion of the private sector
to deliver public goods, that is as true in HIV as in anything else. In India
we are seeing an increase in households' private spend on health care. That
is enormously important. We need to understand that and work with that.
(Clare Short) If I may, because it is the same in Africa and often when
you have useless public systems people turn away from them and spend money
that they can hardly afford in the private sector, sometimes on inappropriate
drugs or on inappropriate care, but if you look at the health spend of poor
people a lot of them are spending ineffectively in private interventions,
whereas if you can pool that resource and get the public sector provision
cleaned up and improved in quality, but recognise that people are willing to
spend money on drugs and somehow pool it, then you can get them a better
service for less money than they were spending in the first place, and that
is the kind of way we tend to go. That is the kind of way in which we tend
to go. If you are very purist and you say "we do not want any private sector
input" you do not get any reform and you cannot improve the quality for
people.
706. That is the point. We also got reactions from Indian people
whom we met saying "if you do not pay for it, the medicine is no good". You
have got to roll with what they believe and what they do to get the proper
programme.
(Clare Short) I think we are.
Chairman: We must run on quickly to multilaterals.
Mr Colman
707. You said at the beginning that UK DFID work is only part of
the international system and we cannot do it all on our own. I wonder if you
could comment briefly in terms of the European Community, the World Bank, IMF
and the UN family. Starting with the European Community, what are the
strengths and weaknesses of the European Community HIV/AIDS programme, what
is its added value and where in the future should it concentrate its
resources?
(Clare Short) If I could make one short preliminary remark. There has
been a tradition in the past that bilateral is best and that spending into the
multilateral system is an obligation that is regrettable. We have changed our
view on that because, of course, getting some leverage into the multilateral
system and getting it to be more effective is getting an international
development system that works everywhere rather than just having some nice UK
programmes. We have put much more energy and effort into improving the
quality of the multilateral system and we have put more resources into bits
of it that work to try to get a more effective system and I am sure that is
right. A more effective system, talking about the EC, the one thing my father
always used to say when you did badly at school was "if things are very bad
it is quite easy to improve" ----
708. Did he say that to you though?
(Clare Short) He always said it to us when we did badly and the other
thing when we did well. The EC's technical work, there have been some very,
very good people in Brussels doing some very good thinking that the Department
admires but not much implementation. It is better to have good thinking in
the middle than bad thinking in the middle and not much implementation, so
that is an advance, but we think that with an agency of that size and with
that funding the EC could do more to implement and release good analysis.
(Dr Lob-Levyt) I completely agree with that. There are some good
initiatives under discussion at the moment with the European Commission to
actually pay money in partnership with WHO to advance the HIV agenda, looking
at commodities and services. I think that kind of way of spending for the EU
where it acknowledges that it is, as yet, less effective on the delivery on
the country level may be one way forward.
(Clare Short) The WHO is an agency that was poorly performing under a
reforming leadership, so we have to watch. The fact that the leadership is
reforming does not mean it is necessarily always an effective implementation
agency but I think the EC are thinking about putting some resources through
other agencies to get some spending going and we have to watch then that it
is quality and not just speeding up the spending but not doing it well. Then
you have World Bank investment.
709. If I can say, particularly we were interested in terms of
whether there should be an HIV/AIDS focus in the poverty reduction strategy
papers arising out of the HIPC initiative? Should the structural adjustment
be handled differently in such areas as, for instance, charging for health and
education or the slimming down of public services staffing?
(Clare Short) We believe the poverty reduction strategy papers is an
enormously important shift in the way of working of the IMF and the World
Bank. I have been recently to Tanzania, Rwanda, there is one being prepared
in Kenya, Bangladesh is just about to start. It is a totally different and
better way of working for the IMF, the World Bank and governments where you
look at your macro-economic strategy, the whole of your public expenditure,
that means revenues, debt relief and aid money, the priorities in different
sectors, and within that, because otherwise people say it is health if it is
all hospitals or education if it is all university students, having it
published and open so everyone in the country can be part of it and then all
donors collaborate behind that instead of having lots of separate projects.
That is the big shift. It is very important. We need to drive it forward
into implementation and then, within that, absolutely HIV should be there.
It is a development challenge to countries and it should be part of the
programme that they have a programme for the nation. I think the World Bank
has been a bit slow on HIV. Is that fair? It has declared 500 million, has
it not?
(Mr Grose) Yes.
(Clare Short) At Durban. But people have to borrow from the World Bank.
It is all very well saying "here you are, here is 500 million" but governments
have got to be wanting to make use of it, so that is a bit of a notional fund
for headlines. The Bank is put under enormous pressure to do that. I think
the Bank is taking it more seriously, is that right?
(Dr Lob-Levyt) Yes, the Bank is definitely taking it more seriously.
Mr Rowe
710. In relation to the EU, my understanding, and I may have got
it wrong, is that at the moment the EU has difficulties when a notional figure
is put into its accounts and it is not allowed to set against that figure the
administration of the programme costs. I think one of the things Chris Patten
is trying to do is to enable them to have the administration costs taken out
of the project money. Am I right about that? If I am, do you approve of
that?
(Clare Short) There is a new agency to deliver services. It will be
allowed to use running costs for some stuff, that is right, which we do as a
Department. We think a separate agency is not ideal but it is the best way
for the EC to go. It does not mean it will be good. We have to watch it and
try and make sure that it is an effective agency. One of the big excuses is
they do not have the staff, they want more staff. We say "use the staff you
have got better, do not ask for even more weak resources to be thrown at this
wasteful operation". So, you are right, but watch the excuse that it is all
hopeless because we will not give them more staff and what they need is even
more resources and more effective programmes that we all run in our nations.
Mr Colman
711. The third part of this sort of hierarchy is the World
Bank/IMF, the UN family. You mentioned about the EC working with the World
Health Organisation. Do you think there is an effective co-ordination within
the UN family and amongst all donors? At which point, if you like, in this
hierarchy do you think it is most effective for DFID to get involved? I agree
with you that a multilateral approach is important but which particular area
would you see as being most effective?
(Clare Short) I think we think that Peter Piot is an enormously good
man, UNAIDS, very dedicated and good analysis. He has been given a very
difficult mandate and a difficult way of working, getting a whole series of
UN agencies to work together. Their implementation has not been very good by
the UN family. The commitment to do more implementation and make it more co-
ordinated is very important. In general the UN family is much less effective
in general than it should be. The reforms that Kofi Annan has brought in to
get them all in one UN house in a country and have some co-ordinated view of
what is needed in that country so they can complement each other, not compete
with each other and work separately, is absolutely right but there is a long
way to go to get that implemented. I think that is true on the HIV/AIDS work
too. I think we are strongly supporting the effort to have a co-ordinated
programme in Africa but that has yet to be implemented.
(Dr Lob-Levyt) I think I would agree with you. An examples of a new
partnership is the International Partnership Against AIDS in Africa which has
taken a long time to get going. It is beginning to look a lot more promising.
We have been actively involved in discussing how that partnership will
operate, what it means, and ensuring that African governments are very much
in the leadership of that. That is the way we see ourselves interacting.
712. Is that working with EOAU?
(Clare Short) Are the EOAU involved? The Economic Commission for Africa?
(Mr Grose) They have been. They have been discussing it. They are now
proposing a major conference for presidents, ministers of finance, ministers
of agriculture, ministers of education and so on.
(Clare Short) Is that the Economic Commission for Africa?
(Mr Grose) That is the Economic Commission.
(Clare Short) The UN body based in Addis Ababa.
(Mr Grose) Through the Africa Development Forum. Again, to say it is
happening is not to comment on its effectiveness.
(Clare Short) The real collective answer to your question is there have
been bits and pieces of different parts of the system. We need this sea change
of government lead looking right across all the sectors using all the best
knowledge of the international system, getting it to scale and applying it
across the board. We are just at the beginning of aspiring to that. That
should be what the next real push is about. Everyone needs to improve, donors
need to collaborate more, governments need to give more lead, UN operations
need to come in much more collaboratively behind that effort and we are
nowhere near that yet.
Chairman
713. That is where we have to get to if we are to tackle this
problem.
(Mr Grose) If I can just add to give you a specific example of
coordination. I think DFID works with headquarters of the UN organisations
individually as well as with the UN sector. We also work with the UN officers
in countries. One particular area where there is a lot consultation going on
at the moment is in education, so there are informal work groups going on at
the moment which involve the DFID, the World Bank, UNAIDS as well. It is a
specific example of how there is a lot of flexibility around the kind of
co-ordination that is beginning to happen more and that needs to happen more
and the umbrella. It is also an example of how many players there are and how
you can spend all your time co-ordinating and not getting anything done.
Chairman: Can I ask Mr Rowe to lead us in mainstreaming?
Mr Rowe
714. That leads us neatly into the next question. Is there a
mainstreaming in HIV/AIDS into the thinking of other Whitehall departments,
for example, the MOD, MAFF, DTI and ECGD? What advocacy does DFID undertake
within Whitehall on these issues?
(Clare Short) The first part of the answer is this is one of the big sea
changes in the Department since it was formed as a separate department. The
old ODA was an aid distribution department. We now are invited to take the
lead on all areas of policy affecting developing countries and getting them
into the mainstream of United Kingdom policy. It has been a very, very
important change in our relationship with the DTI and with the Treasury on
poverty and dept and so on, and it is starting to work through our government
and it is unlike other governments. On our work with the Department of
Health, the Foreign Office and so on, I am on a Ministerial Liaison Committee
that meets every six months. These guys do the official level.
(Dr Lob-Levyt) I would say that we are actively engaged with our
colleagues in other departments on HIV/AIDS, and Okinawa was a joint effort
between several departments. DFID happened to take the lead on the health
aspect of the briefing, but we closely consulted with our colleagues. It is
the same on issues like intellectual property rights, we consulted very
closely with the Department of Trade and Industry. I think these are active
and very live discussions to ensure that there is a common line across
government.
(Clare Short) It could always be better, and this is a new kind of way
of working, but it is improving considerably.
715. If there was an effect of HIV on rural agriculture would it
be something that you would talk about with MAFF?
(Clare Short) Agriculture in developing countries? That is our lead.
MAFF is not out there. They are too busy distributing.
716. Your strategy paper, "Illicit drugs and the development
assistance programme" makes no mention of HIV/AIDS, despite the fact that the
unsafe injection of drugs is in many parts of the world the main cause of HIV
infection. Similarly the issues paper on tourism makes no mention of HIV/AIDS
despite the relevance of sex tourism. I wonder whether you intended to revise
the illicit drugs strategy paper to take account of HIV/AIDS and what does it
propose to support? Do you propose to support to reduce the risk of infection
among drugs users?
(Clare Short) There is a drugs paper that I should have asked the
Department to prepare and this is because there is a terrible danger in
anti-drugs work of throwing money around to bribe people not to grow drugs,
so you get the next group of peasants starting to grow them and waiting for
the bribes to come, as they did in Afghanistan, and it is hopeless, or you
bomb people who have no other option for their lives. I have the Department
- I presume this is the document that we are talking about - to talk about the
conditions in which anti-drugs work would be developmental, which is basically
to offer very poor people who grow drugs a legitimate life that is better,
which is both crops and legitimacy in their lives, that their children get to
school and so on. We are not willing to have our budgets sucked away in
gestures and bombing campaigns. It happened in Afghanistan. UNCD paid a lot
of peasants not to grow drugs, so a bigger sway of peasants all around then
went and planted some.
717. To have some set aside.
(Clare Short) Indeed. That document - which I think is the document
that you are referring to - was prepared for those purposes, to try and say
when you can do anti-drugs work in a developmental way. It was not really a
treatment of drug users document. I assume we are talking about the same
document. On the other hand the Department does do a lot of work, for
example, when I was in Russia we were paying for a needle exchange programme
in Yekaterinburg where there is a situation of beating up drug users. Within
our health prevention and HIV prevention - there is a spread of HIV coming on
the back of drug abuse in Russia - we are doing it there. I think that is
that document. The tourism document, I hardly remember. Can I say that we
will look at it? I do not know who reads it or how important it is, but I
will look at it and I will come back to the Committee.
718. On the issue of disability and HIV, it is well known that in
many countries people with special learning difficulties are particularly
vulnerable to sex abuse. I am delighted by your disability issues paper,
which is a very good start, but I would like to have your assurance that the
position of people with disabilities in relation to HIV/AIDS is in your
thinking.
(Clare Short) Thank you for that. I think pressure from you, and
others, helped us to get that work done. The problem we have in very poor
countries is that life is so mean and hard that there is inadequate provision
for anyone, and people with disabilities are just not focused on at all, as
you know. We are trying to ensure that that is corrected. I have to say in
no discussion that I have ever had has vulnerability of people with
disabilities in relation to HIV been discussed. There is no question that a
lot of young women are very vulnerable to unwanted sexual activity. There is
even this myth of if you can have sexual intercourse with a virgin or a very
young person you might get rid of the infection and that kind of abuse. I am
sure you are right to flag vulnerability of people with disabilities and we
need to think about it. I cannot guarantee to you that we can reach right
through, but we should try to incorporate it.
719. Does DFID have an explicit HIV/AIDS policy for its own staff
both in London, Glasgow - East Kilbride I should say - and in overseas
offices?
(Dr Lob-Levyt) In several of our overseas offices they are developing HIV
strategies for their staff. Some are implemented and it is one that we
recognise that we now need to look at across the whole organisation, and that
is under way at the moment.
Chairman
720. In the few minutes available to us can we look at the impact
of HIV/AIDS. As we have discussed, HIV/AIDS is exacerbating a shortage of
teachers in developing countries. In Zambia we found that there were more
teachers dying as a result of HIV/AIDS than there were teachers being trained
in the teacher training colleges. So clearly the education of children is
going to suffer very badly. What is more, it is leading to the withdrawal of
children, particularly of girls, to go and look after family rather than be
in school. We wondered how DFID is modifying its education programmes and
strategies to take account of this terrible effect of HIV/AIDS? Are there
proposals to remedy staff shortages and innovate so as to provide education
for those children obliged to leave formal schooling, and presumably, what we
are thinking of here is, of course, carrying on schooling at home?
(Clare Short) You are absolutely right. Of course, it is not just in
the education sector, it is in all sectors, and in the private sector and so
on, but the extra difficulty effecting education is that it is depriving the
next generation of opportunities. As you say, with families that have people
who have died or who are ill, children being withdrawn from school to help
care or to farm or whatever is a second consequences, and we are starting to
think about how we can address this. I have somebody here. Are you allowed
to talk to somebody sitting there? David Clarke is leading work on this.
721. If he would come to the table I would be grateful. Your
name, please, sir, for the record?
(Clare Short) David Clarke.
(Mr Clarke) We are moving quite quickly, though there are clearly
constraints. One of the issues is to galvanise an international response,
because, as the Secretary of State has said, we are one among many actors in
this and primarily we have to ensure that governments respond effectively
through developing national strategies, and we are working with governments
in our partner countries to do this. Where they have strategies in place we
are looking at ways to support. We are also working with the University of
Natal in Durban to a develop a tool kit and education manual for managers that
can be tried out in SADC regions to develop responses within the Ministry of
Education there. We are working at a variety of different levels with other
agencies to develop a common approach, with governments in country programmes
and with the research community as well so that we find our best practice and
new tool kits for development.
(Clare Short) Could I add, in many countries there is not a commitment
to universal primary education already, let alone these extra teachers. The
logic is that you train even more teachers and you make special efforts with
children and orphans, but you need to have a commitment to universal primary
education to then make that special effort and in some countries we do not
have that.
722. Without that you cannot make any progress, I quite agree.
(Mr Clarke) One way that we are trying to use this as a window is to
focus attention on impact studies. We are providing support for an impact
study on HIV/AIDS in the education sector in Botswana and working with other
agencies to ensure a sufficient quantum of impact studies are available so
that we can assist governments in interpreting what is happening and
mobilising effective response.
723. Can you give us an example of an effective response which you
would actually want to support and see implemented?
(Mr Clarke) It is very early days and we are looking at elements of
that. It is fair to say that Uganda has perhaps been the best example, but
even there, within the education system, improvements could be made.
(Clare Short) It is this catching up. People have all thought health
and now education people need to think about the consequences for teachers and
for children, and for the curriculum as well, children need to be taught about
protecting themselves and changing sexual behaviour.
724. This is human behaviour change that we are dealing with and,
therefore, you have to have that resource, for example, your educational
programme in the boys high school in Cassunda were very dramatic and did
indeed have an effect on those young men and women who were taking part in
that. One of the responses that I wondered whether you were thinking about
was actually increasing the number of programmes that you are doing in schools
to help them protect themselves?
(Clare Short) I met the Botswana Minister at some meeting and I know
they were looking at the primary education curriculum, which is what you need
to do. Peter Piot always says it is younger people who are more capable of
changing their behaviour. It is very difficult to get older people to change.
It cannot be just us again, it has to be learning the best lessons and then
trying to get that into the thinking of government and education ministries
and backing that shift in thinking - which the work David is heading up is
trying to do - to encapsulate the best thinking we can get and spread it about
and get educators to start thinking like this.
725. I think what you are saying to us is that in fact Mr Clarke
is leading a team who are thinking about the effects and this is early days
and you have to develop programmes, and you recognise that you do have to do
that and you are doing that, but everybody has to join in if you are to have
an effect?
(Clare Short) Absolutely, and it is not just us developing programmes,
it is getting it into the mainstream thinking and the whole international
system and national government system, and looking at the particular effects
on the education sector, which are very serious.
Chairman: I know that the Secretary of State has to go to a Cabinet
meeting in 10 minutes.
Mr Rowe
726. My work with CSV, among other things, has given me some idea
that there is scope in some of those countries for organising young people
into teams, in a sense. An inappropriate example might be the Boy Scouts, but
this sort of thing. It seems to me, particularly where you have enormous
numbers of orphans, the possibility of actually encouraging countries to
mobilise some of their young in a disciplined organised way, rather than
leaving them to struggle and be victimised by oppressive employers, is worth
at least putting on the table.
(Dr Lob-Levyt) We have a number of programmes that we are supporting
already with orphans through NGOs to tackle exactly this increasing problem
of increasing number of HIV orphans. It is whole generations that are going
to miss out.
Chairman
727. Which leads me into this question that I wanted to put to
you. Does the effect of HIV/AIDS on households, in particular the large and
increasing number of orphans, have any implications for child labour policies?
How is DFID supporting communities to assist children, the elderly and others
in distress as a result of the impact of HIV/AIDS on households?
(Clare Short) We have always been clear that to think you could have a
blanket opposition to child labour was unrealistic. People do not talk much
about child labour in Africa, but in fact there is masses of it and lot of
children work in agriculture and help out their families and some of that is
fine.
728. From age four.
(Clare Short) Are not our school years supposed to be explained by the
fact that a lot of us used to help our families in the summer and that is why
we have our long holiday? Probably managed in a loving family there is
nothing wrong with that, but when it becomes an obstacle to children being
educated it is this double burden that they lose their childhood and their
life prospects and their children's life prospects are damaged. We have
always taken the view that you have to try and improve the household income
and get the children to school rather than oppose them working at all. I
think the consequences of HIV, and more orphans and more poor households risk
children working more and more and children not being in school. That means
that effort needs to be strengthened. We are trying to work more and more
with the International Labour Organisation, which has been a good norm setting
organisation, but needs to strengthen implementation efforts. I do not think
our strategies are wrong, but there are going to be more instances and more
children in danger of working long hours and being excluded from education.
729. We have to do more of it, because of the HIV/AIDS infection.
(Clare Short) Absolutely.
730. On the private sector, how is DFID engaging with the private
sector in responding to HIV/AIDS? We took evidence in South Africa to suggest
that the private sector ought to do a great deal more. Is there any potential
in using the private sector as a means of prevention education, not only to
work forces, but to whole communities and as a provider of condoms, testing
and care facilities?
(Clare Short) Some firms have been very progressive and I think some of
those were covered in the evidence.
731. Yes, they were.
(Clare Short) And obviously others were not. I think the private sector
is now included in the UN led co-ordinated effort for AIDS in Africa. Some
parts of the private sector have done well. They should be included in the
whole sense of responsibility and partnership. We, like everyone else, can
do more, but again we need to get them into the international systems that
they are engaged everywhere by all governments and all players, rather than
us just go out and find a couple of firms to work with.
(Dr Lob-Levyt) There is a huge number of levels of intervention. Those
working with large companies and those working with informal structures of
transport, truck drivers and the companies responsible for that.
(Clare Short) We have done that in India, particularly. The truck
routes have spread.
(Dr Lob-Levyt) There is also working with the private sector using
private sector mechanisms to get commodities like condoms and treatment
further out.
732. It seems to me though, Secretary of State, that in fact we
have to get the private sector more sensitive to these problems. If they can
redesign their operations we could reduce the incidence of transmission of
HIV/AIDS. For example, if you use less people - men particularly - who are
living away from their families for prolonged periods, ie, truck drivers,
hence the spread of the AIDS, if you have a mind that the new mind should not
separate families, and those sorts of things should be implemented by the
private sector and we should try and promote this to, certainly, British
investors in Africa or elsewhere.
(Clare Short) Absolutely, and I think the responsible private sector
knows, because just like teaching they are losing their trained people and it
is an enormous cost and they have to train two for one or three or whatever
it is, and that is desperately wasteful, especially in places where skilled
and trained staff are hard to come by. I am sure more effort can be made.
There are some companies that have done very good work and some of these are
covered in the evidence we gave to you. The inclusion of the private sector
in the co-ordinated effort is part of it.
733. I tell you one thing, you took us to the 600 strong brothel
in Bogra in Bangladesh and the private sector owned that brothel and you have
a programme in there to educate the sex workers and to teach them how to have
safe sex. When I asked the owners of that brothel whether they thought this
was helpful to their business they said, yes, it was very helpful and it
brought in more clients and they were very grateful for your effort. When I
asked them whether they would like to take over and pay for these efforts they
said, no, it would be far too expensive. It seems to me that we have a lot
of work to do with the private sector if that instance is typical.
(Clare Short) The worst employment conditions in general tend to be the
local private sector. People always think of international companies being
exploitative, but you tend to get the worst conditions in the local private
sector. Jenny Tong, when she was a Member of this Committee, was critical of
some of the reproductive health care work we had done in garment factories in
Bangladesh, but our starting point is the people and their lives. If we can
get in and get something moving we are always looking to move to
sustainability, which means not us, if you can possibly get there, but I am
sure it is right that we are opportunistic and getting--- I have visited what
they call floating sex workers in Bangladesh, young girls who do not even have
brothels to work from, and we are doing a programme with them, and teaching
them how to protect themselves. I am sure our approach is right. If we can
get the opportunity to get in and try to change attitudes and get the thing
moving, and then if we can get that to be sustainable by other agencies taking
over their responsibilities, we will always do that.
734. It should have the catalytic effect that you are looking for.
I know you have to go to your Committee. I hope we have not made you late.
We would like to thank you very much indeed for coming and talking to us about
this very serious subject. I am very glad of the optimism as well.
(Clare Short) Well, if something is disastrous you can either tear your
hair out or look for the best possible things that can be done and galvanise
the effort, and that is what we have to do.
Chairman: Thank you very much. Thank you Dr Lob-Levyt, Mr Grose and Mr
Clarke.
