Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 540 - 559)



Mr Robathan

  540. I will move on from that. I think I have made my point. The second point is a very important one about the Communique« 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 Communique« 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.

  541. 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 £15 million in 1992-1993 to £55 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.

  542. A politician's 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.


  543. 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 £20 to 30 million over the next three years per annum.
  (Clare Short) Is that commitment or spend?

  544. £100 million in total over three years was the evidence given to us. Your figure today suggests £50 million I think.
  (Clare Short) 55 in 1999-2000.

  545. 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.

  546. 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.

  547. 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.

  548. 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.

  549. 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.

  550. 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.

  551. 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.[1]
  (Clare Short) Okay.

Mr Rowe

  552. 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

  553. 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.

  554. Regionally?
  (Mr Grose) We would have to come back to you on that.[2]

  Chairman: If we can get that in a statistical answer. Tony Worthington, could you continue on this.

Mr Worthington

  555. 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.

  556. 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.

  557. 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.


  558. 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.

  559. 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 political commitment and increased spending in Zambia and also in Tanzania.
  (Mr Grose) Brazil.

1   See Evidence p 265. Back

2   IbidBack

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