Select Committee on International Development Fourth Special Report


The challenge of HIV/AIDS

48.  We appreciate that the priority has been to get enough food of any type through to the hungry, but trust that DFID and the international community will—now that the food pipeline is more secure—seek to improve the nutritional content of food aid, to maximise its effectiveness in addressing the needs of those infected with HIV. (Paragraph 143)

Inadequate nutrient intakes can increase the risk of illness even for people who are not HIV-infected. However, current knowledge about nutrition and HIV is still patchy. We know from metabolic studies that HIV affects the absorption and utilisation of nutrients, but as yet there is very little robust evidence that dietary or nutritional interventions can reduce the progression of HIV to AIDS and, to date, the World Health Organization has not made any specific recommendations concerning intakes of protein, energy or micronutrients for people living with HIV/AIDS.

The nutritional quality of humanitarian food aid can be improved by including a wider range of foods in the ration and/or by fortifying relief foods with micronutrients. Corn-Soy Blend (CSB), which is fortified with a range of vitamins and minerals, is included in WFP general rations when sufficient quantities are available, but availability is variable because CSB is relatively expensive and production capacity is limited.

An alternative to improving the quality of humanitarian food rations across the board is to target specific foods (eg CSB) to people with HIV—but in order to do this we need to be able to identify these people. Although HIV prevalence is high in southern Africa, very few individuals know their HIV status, and because of social stigma, some who do know they are HIV-positive do not wish to be identified as such. An easier option is to identify people who are chronically ill, since in southern Africa many who fall into this category have AIDS. A significant limitation of this indicator, however, is that it does not identify people with aysmptomatic HIV infection. Another factor that affects the precision of targeting is the tendency within poor households to share whatever food is available.

Our preferred approach is therefore to channel food to households with chronically-ill members, through home-based care programmes. DFID supports home-based care in southern Africa through partners such as the International Federation of the Red Cross and John Snow International (UK). Large-scale success with this approach, however, requires strong civil society networks with national coverage and a strong basic health service, both of which depend on large numbers of competent well-supervised staff. Human resource constraints are often the greatest challenge to implementing such programmes at the scale needed.

49.  Targeting of assistance is crucial. Targeting is impossible if agencies do not even know where the hungry, and particularly the most vulnerable groups of people, including orphans, are. We would like to know what steps DFID is taking, in partnership with other agencies, to improve the mapping of need. (Paragraph 144)

Knowledge of local communities is needed in order to identify and target the households in which vulnerable people live. Such knowledge can often be tapped through locally-based NGOs, faith-based organisations and local relief committees.

In Zimbabwe, DFID has provided technical assistance and funding to Unicef for a national nutrition and health survey designed to generate district-level estimates of child malnutrition prevalence and various indicators of health status. Results will inform the targeting of both food and non-food assistance. Several NGOs in Zambia are working with communities to understand local perceptions of vulnerability and to standardise these to ensure consistency of targeting across districts.

50.  Efforts must be made to assist HIV-affected households through the provision of appropriate labour-saving technologies, by encouraging diversification into less labour-intensive crops, and by working out how to ensure that agricultural know-how is passed down through the generations despite the early death of HIV-infected parents. (Paragraph 145)

International crop research institutions are already looking at changes in their plant breeding programmes to introduce traits in seeds and planting materials that would change the way that smallholders operate. It is in this field that genetically modified organisms that are weed resistant would provide massive benefits to labour-constrained farmers. But such techniques are controversial and to some countries unacceptable. Greater use of irrigation, where smaller areas could provide both food and income would obviate the need for large dry land crop production. DFID is funding research and piloting such schemes. Labour saving technologies should not be confined to HIV—affected households. Their application to all small-holders would increase options for directly increasing agricultural output or increase the availability of labour for non-agricultural activities, which surveys show frequently contribute more than agriculture to rural livelihoods. School curricula will need to be reviewed to ensure that they also contribute effectively to the life skills that will be required for future generations in the affected rural areas.

51.  We encourage DFID to consider the possibility of designing a public works programme to provide extra labour for child and grandparent-headed households at critical times, in return for food, cash, or agricultural inputs. (Paragraph 146)

Ideally, a social protection programme that provides cash to such households would enable them to use the money for the hire of labour or to buy basic foods. Schemes such as the "inputs for work" programme in Malawi provides for communities to identify 10% of beneficiaries who cannot work but who are considered in need of support. This is a form of community support similar to traditional networks that exist in rural areas, many of which no longer operate because of increased poverty and the impact of the HIV/AIDS epidemic. The work involved is normally on public infrastructure maintenance but could be extended to provision of labour directly to affected households. We need to gain a greater understanding of sharecropping systems, which operate in many countries.

52.  DFID officials suggested to us in evidence that a first approach to improving capacity ought to be through enticing emigrants from the countries of southern Africa—perhaps emigrants who have studied and stayed in North America or Western Europe—back to southern Africa. Increasing technical assistance to enable countries to hire expatriate expertise, whether from other parts of Africa, other parts of the developing world, or elsewhere, should be a secondary step. (Paragraph 148)

There is a striking lack of human capacity in some Southern African countries, partly due to HIV/AIDS and partly to migration for economic or political reasons—some estimates suggest that 40% of all professionally trained Africans live outside Africa. There are several possible ways of increasing the capacity of African governments, ranging from short-term use of expensive Northern consultants to a gradual increase in the output of trained graduates in those countries. There is increasing evidence that one effective means of addressing capacity constraints would be to pool donor resources for technical assistance and allow the government concerned to judge which of the options would be the best use of those resources. DFID is discussing this model with the World Bank and other donors in a number of countries.

53.  Access to essential medicines must be improved, and provision must be made within the WTO's agreement on Trade-Related Aspects of Intellectual Property Rights for the production of more affordable drugs for public health purposes. Part of the international response to the HIV/AIDS pandemic must be a more flexible application of patent rules in developing countries. The USA and its pharmaceutical industry must not be allowed to obstruct unilaterally such important and sensible initiatives. (Paragraph 149)

We agree, but safeguards in TRIPS need to allow for either production or access in countries with insufficient manufacturing capacity. The UK Government supports a more flexible application of patent rules but these must be in accordance with TRIPS and its safeguards.

54.  In our view, whilst efforts should be made to improve the affordability of ARVs, this must not distract donors and governments from the need to focus on basic health-care systems. (Paragraph 150)

We agree that the importance of health care systems is paramount. Indeed, health services must be strengthened if antiretroviral therapy—which is much more than just antiretroviral drugs—is to be managed effectively. We see the prospect of affordable ARV drugs as an additional incentive for strengthening health systems. In addition to refining our corporate position on antiretroviral therapy, we are working with government and other partners in southern Africa to improve quality of health services and equity of access. Strengthening health care systems and improving affordability of ARVs need to proceed simultaneously.

55.  We urge donors, NGOs and governments to do their utmost to promote improved understanding of HIV/AIDS, and to lay the foundations on which attitudinal and behavioural changes are built. (Paragraph 151)

We agree that changes to knowledge, attitude and behaviour are vital and we work with a variety of partners in an expanding range of sectors to promote understanding and appropriate responses.

56.  In January 2003, the USA announced that it will treble its spending on HIV/AIDS to $15 billion over the next five years. We applaud the USA for taking this step, and for demonstrating the priority which they attach to the fight against HIV/AIDS. We hope that other donors will be encouraged to do the same. We are concerned however that only $1 billion of the new money will be channelled through the Global Fund. The rest is to be distributed bilaterally, and will therefore be more subject to pressures from domestic interest groups which object to the linking of HIV/AIDS and reproductive health issues. It is of course vital that money is spent effectively, and every effort should be made to ensure that the Global Fund is effective, but marginalising multilateral initiatives is surely counter-productive. (Paragraph 152)

DFID have pledged $200 million over five years to the Global Fund as we believe it can play an important part in the fight against HIV/AIDS, TB and malaria, by providing drugs and commodities. It should, however, be seen as one of a number of strategies designed to improve basic health care in poor countries. Wherever appropriate, donors should aim to support the strengthening of effective and sustainable health systems and the delivery of HIV/AIDS strategies through partner governments' own planning and budgeting cycles, with the Global Fund providing support behind these other strategies. DFID has committed over £1.5 billion since 1997 to support the development of health systems in poorer countries. Strengthening such systems is vital if drugs are to be safely and sustainably supplied to the poor. The UK welcomes the US long­term approach to funding, which is vital to secure a long­term vision and financial framework within which the Global Fund can operate.

57.  The focus of efforts to tackle HIV/AIDS should be on basic healthcare systems. However, we urge donors, including the UK, to not marginalise the Global Fund, but to work to make it more effective. The language used by the UN's Special Envoy for AIDS in Africa may have been extreme, but the sense of urgency which he injected is welcome. If southern Africa is to move from crisis to food security and sustainable livelihoods, responding effectively to the threat of HIV/AIDS must be integrated into all stages and aspects of relief, recovery and development now. We therefore support the requests made by Oxfam and SCF-UK to the international community to ensure that all programming and funding activities respond to the impact of HIV/AIDS; to increase funding for food aid and food aid that meets the needs of people infected with HIV; and to increase funding for non-food needs including health, nutrition, water and sanitation. We look forward to hearing how DFID is taking account of HIV/AIDS in its continuing response to the immediate crisis, and in its work with partner governments to lay the foundations for longer-term development. (Paragraph 153)

DFID had a key role in getting the Global Fund (GFATM) established, and we continue to work with partners to improve the way GFATM works. To make the most of the opportunity afforded by GFATM, complementary engagement at country level is also required. At country level, DFID works with partners to ensure that countries' bids to GFATM are designed to strengthen rather than undermine the health system or any other component of the country's capacity to respond to HIV/AIDS.

We agree that HIV/AIDS prevention and mitigation must be mainstreamed into relief, recovery and development and have taken steps within our own programmes to do this. As regards non-food humanitarian needs, we have provided regional support to WHO to strengthen capacity for disease surveillance and timely response to outbreaks (eg cholera). In Malawi, DFID support to WHO has led to improved coordination of the emergency response and expanded provision of sexual health services and emergency obstetric care. In Zimbabwe, DFID has responded to emergency-related health and nutrition needs by providing essential drugs and by supporting Unicef to provide training and commodities to improve the treatment of severe malnutrition in health facilities.

In the transition from relief to development, national leadership on HIV/AIDS is crucial and national multi-sectoral coordinating bodies (eg National AIDS Councils) have a key role. In addition to working closely with such bodies, DFID is supporting a regional HIV/AIDS programme that includes Lesotho and Swaziland, and working to raise the profile of HIV/AIDS within SADC.

From a vicious circle to a virtuous circle

58.  We urge DFID, with its partners, to consider the proposals made by Professor Kydd and Dr. Dorward, and to examine what a poverty-reducing "ecology of variety" might look like, and how it might be nurtured in southern Africa. We also encourage DFID to continue its work in helping healthy civil societies to grow in the countries of southern Africa. Civil society provides an important counter-balance to government, making governments more accountable to their electorates and improving governance. Finally, of perhaps greatest importance, we would like to hear from DFID as to how it plans-—with its partners—to help to build the capacity of governments, and key ministries such as those concerned with agriculture, education and health. (Paragraph 156)

Much of DFID's work in those countries affected by the humanitarian crisis where we have programmes is focused on improving government capacity. In some cases this work is directly related to food security issues, and in other cases there is a strong but indirect link, including through support for Education and Health Ministries. DFID is also supporting SADC in its role in providing regional capacity for forecasting and assessing vulnerability. DFID is helping in a number of ways to draw out key lessons from the present crisis. For example we are funding the ODI Forum on Food Security in Southern Africa which will allow the sharing of experiences and build on practical experience and academic studies to develop strategies for improving response to future crises.

59.  Africa is missing the Millennium Development Goals partly because donors are missing the 0.7% target. We once again urge the UK Government to make swift progress towards its target of providing 0.7% of GNI in aid, to set out a timetable for meeting this target, and to encourage other donors to do likewise. We welcome in this regard, the Chancellor's innovative proposal for an international financing facility. On trade, we urge the UK Government to press its EU partners, and to press them harder, to agree to substantial reform of the Common Agricultural Policy. It is disgraceful for the developed world to subsidise over-production and the dumping of surplus agricultural products, and to restrict access to the EU's market, whilst preaching the virtues of trade liberalisation to developing countries. (Paragraph 157)

The 2002 Spending Review provided for an increase in the UK's aid budget to 0.4% of GNI by 2005-06. This will mean that the UK will exceed the average European Union ODA/GNI target agreed last year. The recent proposal by the Chancellor of the Exchequer and the Secretary of State for International Development for an International Finance Facility is intended to allow a doubling of global ODA in the years to 2015. We are discussing this idea with key partners. We agree on the need for the EU to agree substantial reform of the Common Agricultural Policy.

60.  We urge DFID—particularly at a time when WFP's Executive Board is chaired by a DFID representative—to help WFP to make progress on three fronts: one, to consider a change to WFP's funding regime, to provide it with some predictable base funding; two, to engage more with a wider range of donors such as India, Russia, China and the oil-exporting countries; and three, to encourage donors including the USA to provide cash donations rather than food, in order to increase WFP's flexibility and ability to deliver timely and effective humanitarian assistance. (Paragraph 159)

We agree. Our analysis is that, in volume terms, the donor community generally responds well to major crises, but that (a) there are often problems in mobilising funds in the early stages of a crisis and (b) there is a risk that less high-profile emergencies remain under-funded. More predictable funding, more donors and more cash would help in these areas, as would an agreement to increase the size of WFP's Immediate Response Account, which provides funding on a replenishment basis in the early stages of a crisis.

However, a successful response is not just about the level of contributions. Other actions are needed to ensure that future humanitarian needs are promptly and effectively covered. For example, we need to encourage WFP to improve: its needs assessment and targeting; its measurement of the impact of its interventions; and its coordination and coherence within the international community's response to crises and rehabilitation needs. DFID is working on all of these areas through the Executive Board and in policy discussions with WFP. DFID is also working to encourage a more collegiate approach by donors to addressing WFP's humanitarian needs and challenges.

61.  Moves to enhance the role of SADC are a matter for the member states themselves, involving, as they do, sharing of responsibility and even sovereignty. But they could provide one way of enhancing the region's food security and prospects for sustainable development. As DFID noted in evidence, moves towards regional cooperation and economic integration are in line with the New Partnership for Africa's Development (NEPAD) agenda. DFID should encourage governments in the region to consider seriously the benefits which enhanced coordination of policy through SADC might confer. (Paragraph 162)

We agree. The importance of policy analysis and reform is fully recognised by SADC. As far back as 1994, at the first conference of the Ministers of Agriculture in Harare, it was agreed to support the establishment of a regional policy network to enhance the capacity for policy formulation and analysis in the Southern Africa region. However the Food Agriculture and Natural Resources Policy Analysis Network (FANRPAN) was not established until 2002, and then with donor funding from the US and France.

Comparative policy analysis within the region is now taking place but the challenge remains to obtain the political will to translate this into policy changes. Given the poverty dimension of this crisis the main vehicle for influence for DFID will be the country PRSP processes, but with an increased emphasis on food security and the regional implications.

International development, human rights and accountability

62.  We urge DFID to encourage its governmental partners to pay more attention to rural livelihoods and food security in their PRSPs, and trust that the World Bank will be supportive of this move. (Paragraph 164)

DFID does not press for particular issues to be emphasised within PRSPs. But we do support national governments to develop PRSPs that reflect the feedback from consultation processes, working groups and policy analysis (including PSIAs). Where PRSPs do not appear to reflect the priority given to rural livelihoods and food security issues within these processes we will work within donor co-ordination groups and international fora to encourage national governments to pay greater attention to them.

63.  "Good governance" must be more than a badge given to countries which accept the donors' policy advice. Good governance, fundamentally, is about being accountable to those who one is supposed to serve. Governments, if they are to be democratic, must be accountable to their citizens. Donors, in their use of policy conditionality, must take care not to undermine the relationship between developing country governments and their citizens upon which true good governance is based. As Clare Short recently wrote: "The old approach to aid, with a plethora of projects, reporting requirements, conditionality and management systems, undermines sovereignty and accountability." We would welcome more information about DFID's work on defining and assessing standards of governance. In addition, we encourage DFID to show leadership in the donor community and put itself forward for the donor review process which is envisaged as part of (NEPAD). (Paragraph 166)

We agree that governance is about accountability and that the relationship between governments and donors must not undermine domestic accountability. To that end we are committed to providing our assistance through a range of instruments in such a way that deliberately strengthens local systems. Where appropriate, budget support is used in pursuit of these aims, as well as more directly providing the resources for governments to deliver better services to their people.

In considering both economic and political governance, we seek to work jointly with our partners, helping them to meet their own commitments. As far as political governance is concerned, we work to improve civil liberties, structures and patterns of political representation and the effectiveness of institutions. In all these areas we are concerned primarily with the direction of change, as we recognise that all countries are at different stages in their development.

In providing assistance, the UK recognises that governments and donors alike are mutually committed to the achievement of the MDGs. We recognise therefore that as a donor, the UK is accountable for the quality, quantity and coherence of our assistance. We thus strongly support the ideas underlying "mutual accountability" in NEPAD and willingly open ourselves up for peer review. Indeed, the UK is at the forefront of urging donor colleagues to adopt this important new agenda. We do so at both country level and in a range of international fora.

64.  We welcome DFID's commitment to the humanitarian imperative and its efforts to remain free from undue political interference, in what have been very difficult circumstances. (Paragraph 167)

65.  DFID plays a major role in the international humanitarian system in its own right as well as a supporter of UN agencies. We believe that DFID and other donors should be accountable for the humanitarian assistance they provide; such accountability must begin with clarity about the purpose and methods of humanitarian assistance, and about how the effectiveness of humanitarian assistance might be measured. (Paragraph 168)

DFID is politically and legally accountable in the UK for its humanitarian aid. DFID has published and widely disseminated its principles for humanitarian aid. And DFID's engagement with the major international humanitarian agencies is documented in published strategies for our work with each institution. There is also extensive published evaluation of DFID's humanitarian operations.

66.  If the right to food is to mean anything, someone—governments, organisations and individuals—should be held accountable when the basic human right to food is violated. (Paragraph 169)

We agree that governments should be held accountable for their relevant international obligations, including under Art 11 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). We take the view that only States can have obligations under international human rights law and that such obligations are towards individuals within States' own national jurisdictions rather than towards other States. Accountability is essentially political and needs to take place in the framework of each country's national political and legal system. But international pressure, along with scrutiny by the relevant treaty monitoring body and work through the Office of the High Commissioner for Human Rights is also relevant.

67.  We urge DFID to consider how progress towards realising the right to food might be furthered by improving accountability within the international humanitarian system, and what this might mean in practice for the provision of food security in southern Africa. We would be interested too, to hear DFID's views about the wider relationship between international development partnerships, sovereignty, and accountability. (Paragraph 172)

We do not believe that accountability of international humanitarian agencies has been a serious obstacle to realising the right to adequate food of individuals in developing countries. There has on the whole been a strong international commitment to providing humanitarian assistance during humanitarian crises. And practices in the delivery of aid have in general evolved to reflect improved understanding of the impact of aid on the longer-term food security of those communities receiving emergency aid. There is of course always some lag in the recognition of best practice and strong advocacy for change will always be needed. Food security is invariably a priority for poor communities and the most effective leadership will come from developing country governments which have strong administrations that are accountable to those communities and that work closely with international agencies to respond to their needs.


 
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