Examination of Witnesses (Questions 60
- 79)
THURSDAY 8 JUNE 2000
DR JULIAN
LOB-LEVYT,
MR BOB
GROSE, MR
PAUL ACKROYD
AND MS
JOANNA GRAHAM
Chairman
60. You are speaking about anti-retroviral treatment.
(Dr Lob-Levyt) I am speaking specifically about anti-retroviral
therapy, yes. It is part of the wider, broader agenda of the need
to make affordable and accessible drugs including HIV drugs and
vaccine available in poorer countries. We are doing a lot, working
with industry, working with WHO and UNAIDS to explore how this
can be achieved. You pointed out very clearly, as your parliamentary
group pointed out, that it is not just the provision of drugs.
In the case of HIV these are very toxic drugs, complicated to
administer, need quite robust health systems to deliver them.
We have had enormous problems doing them in our own country and
in the United States for example, so it is part of a range of
responses. It is certainly not the magic bullet or the answer.
Ann Clwyd
61. Can you tell us how DFID promotes sexual
health services in developing countries?
(Dr Lob-Levyt) More broadly than reproductive health?
62. Yes.
(Dr Lob-Levyt) We have a very large number of programmes
with governments, very substantial programmes, on reproductive
health, working with governments to establish reproductive health
services, working with NGOs and civil society in the provision
of services. It has been one which DFID has been engaged in for
a long period of time and we put substantial resources to that.
63. Of course health systems in most developing
countries are being stretched beyond their resources as they can
only deal with a limited number of AIDS patients and of course
the loss of healthy personnel due to death and illness. Spending
on acute care is likely to take precedence unless health service
funding improves significantly. I wonder what help you are able
to give in that direction.
(Dr Lob-Levyt) We work in the health sector in trying
to strengthen governments' public health systems and increasingly
working with the private sector and with NGOs for example in the
provision of health services. The roles of governments and ministries
of health are evolving and changing in developing countries to
being responsible for the health sector and health services, but
not necessarily the public provision of all services. Of course
many people in poor countries actually buy their services from
the private sector, so there are important issues about working
with the private sector, be it drug sellers, or pharmacists or
small clinics, to improve the quality and lower the cost and to
provide subsidies for the provision of public health services.
DFID is an organisation which has worked intensively in these
health system issues and you are absolutely right, it is complex.
Many of these public systems are collapsing and need resources,
technologies, better management and planning.
(Mr Ackroyd) Increasingly we are planning our health
sector interventions in the context of a complete sectorwide package
planned with the governments with all donors coming in together.
The idea of this is that you address the planning issues, you
address the systems issues, you look at the priorities and you
make sure that the overall resource allocation is optimal for
the particular situation rather than what we used to do which
was going for the particular project, addressed to the particular
problem. The problem with that obviously is that you do not take
this overall view of what the priorities are. This is an important
way forward of addressing these resource and system issues which
you are quite right to raise.
64. How much additional money is being provided
by DFID to countries to combat HIV/AIDS?
(Dr Lob-Levyt) At the moment the Government is committed
over the next three years to spend £100 million on HIV/AIDS.
We shall vastly exceed that commitment actually. At present we
are spending between £20 and £30 million per year, but
that spend is on a very steep rise, as a number of pledges are
being transmitted, not least of which is the international partnership
against AIDS in Africa for example.
Chairman
65. That is a very small figures, is it not?
Your budget is now £2.6 billion and you are going to spend
£100 million.
(Dr Lob-Levyt) We are committed to spend at least
£100 million over the next three years.
66. One hundred million over three years, so
that is one third of that per annum.
(Dr Lob-Levyt) Yes, but we expect to spend substantially
more than that.
Chairman: I should hope so.
Ann Clwyd
67. How is that going to be shared out between
countries most at risk?
(Dr Lob-Levyt) That will be according to where the
priorities are and the priorities determined by governments largely
in partnership and discussions with ourselves. Clearly the money
would go to those countries where the epidemic has already taken
hold. What is very important about Asia — and this is where
I would expect to see a lot more resources going in the future
— is that we do have a window of opportunity to intervene
there.
68. I have always felt that Asia was rather
left out as far as DFID spending was concerned.
(Mr Ackroyd) You will be pleased to know that we are
hoping to go up significantly in the near future. The way we are
planning this is not saying "Here is an additional sum, where
are we going to allocate it?". What we are doing is in all
our country programmes we are looking at the priority we are giving
to HIV/AIDS and trying to increase that. We shall see, I am confident,
an increase in our spend in all our significant country programmes
on HIV/AIDS which in total in years to come should produce a significant
increase in spend.
69. What would you say the main problem for
health departments in developing countries is? Is it lack of funds?
Is it lack of planning or policies or a combination of all those
things?
(Dr Lob-Levyt) I would say that in the past it has
been extremely difficult to spend substantial sums of money because
of the absorptive capacity of governments to take on board the
money and because of the lack of political commitment to it. I
see that situation changing. I see that there will be an ability
to absorb much larger sums of money in the future. It has constrained
us in the past. May I just correct a figure? I have a figure for
our global spend on HIV/AIDS for 1998-99 financial year which
was £42 million.
Chairman
70. You have given us the figure for the development
of vaccine at £14 million. How crucial do you think is the
vaccine to the control of the epidemic in poor countries, bearing
in mind that it is likely to cost a huge amount of money per injection
or however you take it.
(Dr Lob-Levyt) We have contributed to the international
AIDS Vaccine Initiative and we were the first government to put
this significant amount of money in. As a result several other
donors have now come in and it now has increased resources. One
of the principles of this particular exciting initiative is that
right at the outset of negotiations with industry these vaccines
will be made available at an affordable price. They have been
enormously successful in doing that.
71. But we do not have one, do we?
(Dr Lob-Levyt) No, but they have been successful in
getting those commitments from industry in the vaccines which
are now going to trial which are going to point the direction
for future vaccines. So industry is committed to that principle
and money does not go to the industry unless they commit to that.
It is quite exciting.
72. The trouble is though that the cost of producing
the vaccine and accelerating the programme, as I understand they
are doing, is going to be pretty vast. I do not know what subsidy
they will have to have to deliver it at an affordable price but
I suggest quite a large one.
(Dr Lob-Levyt) Certainly we need a lot more money,
both to develop the vaccine and when we actually have the production
of the vaccine to ensure that those investments are returnable.
73. How crucial is vaccine to the control in
poor countries?
(Dr Lob-Levyt) In the longer term absolutely vital.
Of course you already have people infected and the priority will
be to support those who are infected, but for future generations
there is no doubt that a vaccine, if it were available, affordable
and effective, would completely change the picture of the epidemic.
Mr Rowe
74. How involved is DFID in advocating the human
and legal rights of those who live with HIV/AIDS and in reducing
the stigma attached to the disease?
(Dr Lob-Levyt) Very involved is the answer, both as
an organisation in how we respond to human rights agendas and
we have actually produced a consultation document Human Rights
for Poor People in which HIV/AIDS is covered. That is a combination
of advocacy and political commitments to those principles. It
is part of all our programmes and projects.
75. Are you able to persuade for example governments
to make it illegal for insurance companies to refuse to cover
people? I understand that one of the reason why AIDS never appears
on the death certificate is because of the damage that is likely
to do to their insurance claims, their pension or whatever. How
effective is it to negotiate that with governments?
(Dr Lob-Levyt) We play our part in that, but I should
be exaggerating if I said the British Government could actually
resolve those rather difficult issues. These are issues which
are tackled by UNAIDS and other international bodies and we provide
our strong support for them to do that.
76. When some of your colleagues came before
us I did ask the question about students coming to this country
and other people coming for training to this country. There is
a significant — I do not know how big it is — loss
of the people who either die here or die soon after returning
and the cost either to their government or the NGO which sent
them is very high. On the other hand it raises all sorts of ethical
issues if you try to intervene on that. I just wondered what the
Department's view on this is and what guidance you give to British
universities or training centres and so on.
(Dr Lob-Levyt) At the moment we do not. This is something
we need to think about.
Chairman
77. May I talk about the impact of HIV/AIDS?
One of the key international development targets we have spoken
about before is the universal primary education in all countries
by 2015. With the growing number of orphans and children withdrawn
from school to supplement the family income, what changes have
been made to DFID's education strategy?
(Ms Graham) It is an absolutely key issue in sub-Saharan
Africa and it is right to say that DFID in the first instance
was not particularly involved in prevention and mitigation aspects
of the epidemic in the education sector. It is also right to say
that is changing quite considerably now. We are scaling up our
efforts both to link up with other agencies and governments to
share experiences, learn lessons about how the education sector
can be harnessed in terms of prevention strategies. We are also
scaling up our programmes quite considerably. In particular we
have a programme in South Africa at the moment to produce guidance
for policy makers on how they can integrate HIV considerations
into education policy and that sort of activity is happening in
many of our country programmes at the moment.
78. That is encouraging. Is there a possibility
of home extension of schooling or a form of social security payment
to keep children in school?
(Ms Graham) I must admit I cannot comment on that
particularly, although I would say that certainly the informal
education sector is very important and perhaps might tend to get
overlooked in an effort to work HIV/AIDS considerations through
the education sector. Aspects such as home based care, home based
education will be increasingly important for countries in Africa.
(Mr Grose) DFID is part of an inter-agency group which
involves other bilaterals and other organisations like UNDP and
UNESCO, which is beginning to look for some practice solutions
very much along the lines you mentioned, basically to make sure
children do still get access to education, even if they cannot
attend school as much as they would have done in the past. The
universal primary education strategy is one way which does actually
encourage them or enable them to go to school even if their families
are affected. There are other ways in which schools can become
places where children will learn a broader range of life skills,
for example learning about farming if their fathers are dead,
making sure that the schools offer more than they have in the
past, which makes them more attractive to families which are under
greater stress. This working group is also looking at issues like
human resource development and human resource protection for ministries
of education, to try to make sure that there are enough teachers
available to offer education services to the pupils. It is a very
diverse range of problems and we are joining with others. It is
a late stage but we are now trying to get more involved.
79. What you are saying is that in fact it is
affecting and you are taking into account these things in the
educational sector, which is very important.
(Mr Grose) Yes; very much.
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