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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