Examination of Witnesses (Questions 80
- 99)
THURSDAY 8 JUNE 2000
DR JULIAN
LOB-LEVYT,
MR BOB
GROSE, MR
PAUL ACKROYD
AND MS
JOANNA GRAHAM
80. One of the important areas is clearly the
replacement of the numbers of teachers. Are you stepping up the
amount of money you are devoting to teacher recruitment and training?
(Mr Grose) I am not aware that we are at the moment,
but the programme is coming to headquarters for approval next
month for a large education programme in Malawi, which is one
of the first which is really taking AIDS very seriously indeed
and includes elements to try to find a solution or to help the
government find solutions in Malawi. That undoubtedly would include
a human resource development angle.
Ms King
81. Could you tell us what DFID's view is of
businesses' responsibility in this area? Recently the Secretary
of State was saying if programmes were established to cut infection
rates in the workplace this could be done for a cost of $25 per
employee and lead to a reduction in infection by one third. What
does DFID actually do to try to get employers to introduce these
programmes?
(Mr Grose) Up to now, working directly with the large
employers in developing countries has not been part of our approach.
It has been much more working with government or NGOs. We are
aware though that a lot of the big employers throughout southern
Africa have been working on both prevention and care programmes
and meeting their obligations. The picture is mixed and some have
not been meeting their obligations as much as they should have
done. There is a programme which DFID finance in southern Africa
working in five of the countries of southern Africa which is very
close to being finalised; it is now simply awaiting ministerial
approval in those countries. A large part of it is to help large
mining companies to roll out the very good experience which I
mention in the memorandum where a small group of companies has
had a tremendous effect in reducing STD prevalence amongst their
workers and within the local community. DFID is going to be working
with a larger group of companies to ask how we can help them roll
it out, not to finance the services, which the companies have
to finance, but to provide some of the technical assistance so
that they can do it.
82. Are there any programmes similar to this
in India and Bangladesh?
(Mr Ackroyd) It is an area which we are beginning
to explore. It would be misleading to say we have got very far
with it. We are doing some work in the garment industry in Bangladesh,
we have been talking to some of the large employers' federations
in India who are quite active in these areas. These might lead
to something. There are very attractive opportunities because
you are dealing with large workforces in single places and they
are largely male as well, so it is an opportunity to reach populations
which you would not otherwise reach with messages. If you can
demonstrate to the employers it was actually in their interests
to protect their labour force, you have a win-win situation. It
is something which is very much on our agenda, but we are in the
early stages of working on it.
83. I should not have left out Pakistan. Does
it have a similar prevalence and response in terms of government
response?
(Mr Ackroyd) In Pakistan there is a national HIV/AIDS
programme. It is not terribly well funded, although it is getting
a little more profile. Generally speaking there is not a high
rate of prevalence in Pakistan at the moment. It tends to be concentrated,
interestingly, largely in the drug industry. There is quite a
big problem there of intravenous drug use and that is a problem
area which needs to be concentrated on.
Mr Colman
84. I want to follow up the response of the
business sector and the way DFID is working with them and really
on a joined-up thinking basis, areas like the fair trading initiative,
which is an attempt to ensure that where goods are in fact bought
from abroad they are produced under ethical bases. In your backing
for this initiative are you in fact suggesting that health care,
particularly HIV/AIDS protection, should be part of checking to
ensure that the employer who is employing the groups in the countries
abroad, who are supplying the goods maybe to UK retailers, are
actually looking at this whole area of health care and particularly
HIV/AIDS?
(Mr Ackroyd) I think you are referring to the ethical
trading initiative.
85. Yes, I am indeed.
(Mr Ackroyd) The ethical trading initiative is not
a DFID programme, although it is one which we sponsor. The ethical
trading initiative is an activity by a group of concerned businesses
themselves. What they do is determine what their priorities are,
although we are broadly supportive of it and we provide them with
some funding. I am afraid I do not know the details of exactly
what elements they look at, so I cannot answer that specific question,
but we could provide you with additional information on that if
you wanted us to do so.[5]
86. In terms of any ECGD backing which is given
for projects which are working abroad, maybe the oil industry
in Angola is a very good example of that, where in fact that backing
is done does DFID have an interaction with DTI in ensuring that
areas such as health care and HIV/AIDS protection and prevention
should be part of the advice which is given and attached to any
ECGD agreement?
(Dr Lob-Levyt) The same response that Mr Ackroyd made.
I cannot give you the information on that. We are engaged in other
areas with DTI on pharmaceuticals. That is one to follow up.
Chairman: It is indeed one to follow
up because in not every case is the Department for International
Development actually consulted by the Department of Trade and
Industry. It does need to be followed up.
Mr Colman
87. On national responses, what is DFID's assessment
of the effectiveness of the various national AIDS control organisations
in developing countries? Particularly does DFID prefer to work
through such AIDS-specific government bodies or through health
departments? Which is the preferable way forward do you think?
(Dr Lob-Levyt) You have highlighted the main problem.
They have been located in health departments, they have been relatively
weak, with some exceptions, and we should prefer to see them at
a higher level and outside of health. We are seeing that happening
in a number of countries. We are seeing some of the AIDS committees
beginning to perform a lot better. We are about to put a substantial
amount of some of the funds into Kenya in support of the national
AIDS programme, which is outside the health sector.
88. What is the balance in donor support between
central government initiatives and community-based approaches?
Is there any evidence that one works better than the other?
(Dr Lob-Levyt) I do not think this is an either/or
question but the principles of building up from the community
and reflecting and listening to the communities as the main stakeholders
in building national programmes is the principle by which we work
in all our programmes. That requires direct support to communities.
It also requires national responses through governments.
89. Bottom up is essentially getting the community
support to go forward even if it is central government initiative.
(Dr Lob-Levyt) That is right; absolutely. That is
part of our general "Pro-Poor" development agenda.
90. We have something like seven co-sponsors
of UNAIDS. I am not going to go through the alphabet soup but
how effective do you believe it is to have this situation? How
effective is the international coordinated response of donors
to the HIV/AIDS crisis?
(Dr Lob-Levyt) I should say that UNAIDS has become
an extremely important agency in promoting the better coordination
and raising the political stakes at the highest level and getting
it at the top of the agenda of all agencies and governments. We
will respond very positively to what UNAIDS has achieved internationally
at that high level. We have had some concerns about the effectiveness
at the country level, but we are now beginning to see a lot of
improvements at the country level on that. In terms of coordination,
it may be useful to ask Ms Graham to talk about the Africa Partnership
as an example of coordination of a number of donors' efforts in
Africa which is being led by UNAIDS.
(Ms Graham) The International Partnership against
AIDS in Africa is essentially an initiative to bring together
both the private sector, NGOs, the donors and the UN co-sponsors
which UNAIDS work with. The partnership works at three different
levels. At the international level its main role is advocacy,
the sorts of issues which Dr Lob-Levyt was talking about, getting
HIV/AIDS at the top of the international agenda, as we saw with
the Security Council in January. They also work both at the regional
level and at the country level and this is where we really want
to see the partnership be successful. It is in its very early
stages at the moment, but essentially its objective at the country
level is to work with African governments behind their priorities
and to coordinate all these different actors in the context of
one national AIDS strategic plan. It is in its early stages, it
is being piloted in six countries at the moment and I must admit
the evidence is a little mixed as to whether it is being successful,
but certainly we would want to see it being a success. This is
perhaps part of the key to getting a strengthened response, particularly
in Africa.
91. Do you think the Commonwealth is sufficiently
coordinating its response or do you see the situation where we
should really work through the UN institutions and the UNAIDS?
(Ms Graham) The main role of the Commonwealth would
be in international advocacy and getting HIV/AIDS as an issue
which is spoken about. We saw the Prime Minister speaking about
HIV/AIDS at the recent Commonwealth heads of government meeting
and it was very significant that was on the agenda there. At the
country level it really is this issue of coordination, how we
get donors and civil society and the private sector working together
behind an African government.
Ann Clwyd
92. May I put to you a couple of points made
by a group called Alliance which sent evidence into us? At the
beginning they praise DFID for what they say are some of the most
important innovative activities in the developing world. Then
they go on to say these are seemingly outside any overall strategy
for ensuring a broad impact. DFID is by no means a leader on this
issue amongst bilateral aid agencies. The lack of DFID strategy
is particularly evident in regard to civil society responses to
AIDS as reflected in a recent decision in India to phase out support
to a remarkable Healthy Highways project without ensuring an adequate
transition plan. What would your response to that be?
(Dr Lob-Levyt) Firstly, there are some factual errors
here. The Healthy Highways project has not been phased out, it
is moving into another phase with a different emphasis to the
programme.
93. So you are still supporting it.
(Dr Lob-Levyt) Yes. Secondly, I hope that some of
what we have been saying here today gives you an idea of the high
priority we do place on HIV. Maybe one or two years ago you could
have said that and I would invite the Alliance to come to talk
to us and understand perhaps a little better how things have changed
in the last two years.
Chairman
94. Were you appointed two years ago?
(Dr Lob-Levyt) Actually no. We do have a clear overall
strategy which is reflected in our Better Health for Poor People
document which summarises that internally. We are evolving a much
stronger strategy which also reflects greater regional priorities
and the regional responses there will be.
95. They then go on to criticise the EU. They
say the European Commission has been particularly strong in certain
areas of research. Unfortunately the Commission seems to lack
the necessary political will, bureaucratic structures and the
technical expertise to support community and civil society responses
to AIDS effectively.
(Dr Lob-Levyt) I would judge that the European Commission
centrally has been extremely useful in Brussels in pushing the
HIV agenda with the European Parliament, in pushing and driving
some new legislation in a number of areas for the production of
new pharmaceuticals and for making some very clear statements
of the importance of HIV that is beginning to affect their development
programmes. Centrally I would be rather positive. When we get
down to the country level the general concerns which many share
on the effectiveness of EC programme aid at the country level
is as applicable to HIV/AIDS as any other domain.
96. They criticise the lack of technical capacity
in HIV/AIDS at both DFID and the EU, which they say has constrained
the development of appropriate responses. In contrast the United
States continues to pull more than its weight in supporting developing
country HIV programmes.
(Dr Lob-Levyt) I cannot comment so much on the EC;
certainly there is capacity centrally at the EC; at the country
level maybe a bit less. With DFID I would judge, coming fairly
newly into the organisation and having spent a lot of time visiting
field offices and getting to know colleagues, that we have extraordinary
capacity and in depth in many sectors on HIV/AIDS and that is
being rolled out in terms of mainstreaming our work in many countries
in the world. The evidence of some of my colleagues here who bring
interdisciplinary skills as well as specialist skills shows that
I would contest that extremely strongly and again invite the Alliance
to come to meet some of these people.
97. I am sure they will take up the invitation.
(Dr Lob-Levyt) Yes, I am sure they will.
Mr Robathan
98. I also saw this letter from Jeff O'Malley
about the remarkable Healthy Highways project. May I tell you,
just in case you get the wrong idea, having seen the Healthy Highways
project in Hyderabad, I thought it was remarkable—not everything
which is done as a project to combat HIV is going to be successful
- it was a remarkable waste of time. As I recall, I think when
we spoke to them it was a Friday and during that week they had
had something like one or two people come to the mobile clinic
with a STD. In one week they had seen one or two people with any
sexually transmitted disease, so I do not feel it was necessarily
the most cost effective way of pursuing it. We did mention this
at the time to the people in India. That is not the question I
should like to ask. It is terribly important that we have accurate
data to base this on and Mr Grose was pointing out the difficulties
which we all understand, especially in somewhere like Sierra Leone
where to find a clinic is difficult enough, let alone to find
blood testing. I am looking at the document which is the best
we have, which you put in your submission and it says that in
Bangladesh the adult infection rate at the end of 1997 was 0.03
per cent. I pick on this as an example because if we are trying
to appreciate this problem, we do need as accurate information
as we can get. That seems to me incredibly low. What do you think?
(Dr Lob-Levyt) That is low. That would be a population
based figure.
99. I reckon it is lower than the United Kingdom.
(Dr Lob-Levyt) Absolutely. If you looked in certain
at risk groups, you would see higher rates of transmission. We
need more data and better data to understand how that 0.03 per
cent is actually distributed across society. I do not know what
the latest figures might suggest.
(Mr Grose) I do not have the latest figure for Bangladesh.
I suspect it is probably still under one per cent. That is low
in global standards and very low if you compare it to sub-Saharan
Africa. The real issue is its concentration in groups of people
who have particularly high risk behaviour, such as commercial
sex workers and their clients. The strategy in response to that
is to focus on those groups as it has been in the project I have
already described. That would contain it.
5 See Evidence p. 72. Back
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