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House of Commons

Wednesday 10 November 2004

The House met at half-past Eleven o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Sierra Leone

1. Mr. Win Griffiths (Bridgend) (Lab): What plans he has to visit Sierra Leone in the next three months to discuss progress on the agreement made with its Government on the development of Sierra Leone after the civil war. [197140]

The Secretary of State for International Development (Hilary Benn): I was in Sierra Leone in March this year. During my visit I had wide-ranging discussions about progress on our 10-year agreement. We are about to carry out a joint review of it with the Government of Sierra Leone.

Mr. Griffiths: I am sure my right hon. Friend is aware of the strong feeling in Sierra Leone about our Government's great contribution there, both in ending the civil war and in helping to redevelop the country after it. It is good to see the successful reintroduction of democracy with presidential and parliamentary elections and the first local government elections for 30 years. But will my right hon. Friend provide the extra support that will allow the Sierra Leone Government to clamp down on corruption with their anti-corruption measures, so that private industry can go in with confidence and start the economic development that is so necessary to building on that democratic success?

Hilary Benn: My hon. Friend is absolutely right. A great deal of progress has been made in Sierra Leone, partly because of our efforts; but the challenge for the country now is to build on that success, including the recent local elections. Corruption is, I think, the single biggest obstacle to further progress. That is why we are the main supporter of the Anti-Corruption Commission and, with the Commonwealth Secretariat, have provided four judges to focus partly on corruption cases, as well as a special prosecutor for corruption.

The people of Sierra Leone, however, want to see the Government demonstrate by their actions that they will not tolerate corruption, above all because if they do not tackle the problem it will affect the economic future of a country that has suffered so much.

Angus Robertson (Moray) (SNP): I welcome the progress made in Sierra Leone, but is the Secretary of
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State concerned about regional instability and the latest worrying reports of violence in Ivory Coast? Apparently more than 5,000 people have had to flee to neighbouring Liberia. What efforts can the United Kingdom Government make to ensure that progress in countries such as Sierra Leone can also be enjoyed in countries such as Ivory Coast that are currently going through such a difficult time?

Hilary Benn: The hon. Gentleman is right. The whole region has been greatly affected; not just Sierra Leone and Côte d'Ivoire but Liberia as well.

What can we do? First, we must give all possible support to the efforts being made in Côte d'Ivoire to ensure that the peace process that was on track starts up again. I am pleased that President Mbeki is playing a leading role in trying to ensure that the Linas-Marcoussis agreement, which provided the framework for the progress that has been made in Côte d'Ivoire, is upheld and the fighting brought to an end. We do not need any more instability in that part of west Africa. We know from experience that instability can spill into neighbouring states, and they have had quite enough of it already.

Mr. Kevin McNamara (Hull, North) (Lab): My right hon. Friend will know of the close relationship between Hull and Freetown. He will know that ours was the first city to be twinned with the capital of a developing country in Africa. One of Sierra Leone's problems is inadequate training of local government staff. Hull has pioneered a scheme to deal with that problem. What steps will the Government take to arrange more training for local government agency staff in Sierra Leone, to ensure that there is proper administration not just centrally but, more important, locally?

Hilary Benn: I welcome the links of which my hon. Friend has reminded us. The whole focus of our programme in Sierra Leone is indeed on governance reform. That includes public administration, public financial management, decentralisation, reform of the justice system and parliamentary committees.

Following the achievement of stability through United Kingdom intervention and the work of UNAMSIL—the United Nations Mission in Sierra Leone—the task now is to build the institutions of the state, including local government. The Sierra Leone Government can then begin to do what people look to government to do: meet their needs, educate their children and provide opportunities for economic development.

Remitted Funds

2. Mr. David Heath (Somerton and Frome) (LD): What assessment he has made of the role in international development terms of remittance of funds from individuals living and working in the United Kingdom to families in developing countries. [197141]

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): Remittances from the UK are estimated at between £3 billion and £4 billion, with the Indian sub-continent, the Caribbean and sub-Saharan Africa the leading
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recipients. Remittances are a significant source of income for millions of poor people, making up as much as half the income of those who receive them. In partnership with the private sector and developing-country Governments, we are working to remove barriers to getting remittances to poor people by, for example, promoting competition to bring down costs and better use of technology.

Mr. Heath: I think that the richer countries may be missing a trick. As the Under-Secretary says, remittances from expatriates to their home countries and families can exceed official aid budgets. They also have the advantages of being earned income and money that goes directly to families rather than via governmental routes, which gives remittances greater value. Is there more that the Under-Secretary can do? Can he ask his right hon. Friend the Chancellor of the Exchequer to facilitate remittance transfers, as they are such a significant part of this country's aid effort?

Mr. Thomas: The hon. Gentleman is right that remittances make a huge difference to those who receive them. They mean, on occasion, that children can go to school, and that people can purchase food and access health care. We have established an international taskforce with 15 donors sitting on it, including the Americans, the World Bank and International Monetary Fund, to look at what else we can do to bring down costs and to promote competition worldwide in terms of remittance products.

David Taylor (North-West Leicestershire) (Lab/Co-op): Migrant workers have become a necessary feature of industrialised countries throughout the world and the Under-Secretary has paid tribute to the importance of their remittances to their home countries. Does not he agree that migration is an important aspect of sustainable development? What is the Government's attitude to the 1990 UN international convention on the protection of the rights of all migrant workers and members of their families, which would help to secure those hugely important remittances to home countries?

Mr. Thomas: My hon. Friend makes an important point about the contribution that migrant workers make in our society. I think, for example, of the Fillipino nurses who work at the key hospital that serves my constituency, and the Sri Lankan Tamils who work in businesses in my constituency. On his specific point about the UN convention, I do not have the answer to hand and will write to him with it.

Medical Training (Africa)

3. Tim Loughton (East Worthing and Shoreham) (Con): What support his Department has provided for the training of (a) doctors and (b) nurses in Africa in each of the last five years. [197142]

The Secretary of State for International Development (Hilary Benn): DFID has provided £560 million over the past five years to support health services development in Africa, including the training of nurses and doctors. Of that, an estimated 5 to 20 per cent., depending on the country, is spent on developing the capacity of the work force.
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Tim Loughton: I warmly welcome those figures. One of the things that struck me most when I visited Ethiopia two years ago was being told that there are more Ethiopian doctors in Chicago than in the whole of Ethiopia. That pattern is replicated throughout Africa. In places such as Ghana and Zimbabwe, 70 per cent. of doctors leave within five years of graduation. It is right that we should contribute towards the training of health professionals but crazy that we should then poach them; that is still happening in this country through private agencies. Can the Secretary of State apply his mind to thinking more imaginatively about improving terms and conditions, perhaps as part of the aid budget, to ensure that doctors and nurses stay in their home countries, where they are needed most?

Hilary Benn: The hon. Gentleman is right. We have the code of practice in place and my right hon. Friend the Secretary of State for Health is looking at how we can strengthen it. Individuals make decisions to leave countries to seek employment in other parts of the world, but the hon. Gentleman has put his finger on the real issue. How can we do something, working with developing-country Governments, to make it less likely that people will take their skills and expertise away from the country of their birth and travel to other parts of the world? It is about pay, opportunities for continuing professional development, working conditions, the extent to which they will have access to the drugs that they have been trained to use but which may not be available in the communities in which they are placed, accommodation, and whether their children can be educated if they work in rural areas. When I was in Ghana earlier this year, I had exactly that discussion with the head of the Ghanaian health service. His mind was almost exclusively focused on what could be done in Ghana to reduce the factors that push health workers out of that country.

Tony Worthington (Clydebank and Milngavie) (Lab): The Secretary of State knows that this is an immense problem. As more money goes in to HIV/AIDS and reproductive health, it simply will not be possible to improve health services unless we improve the supply of nurses and doctors. There is no sign of any international effort to tackle that issue. Staff are emigrating; staff are themselves dying from HIV/AIDS and there is a totally unsatisfactory secondary and tertiary health system. Perhaps there should be a World Health Organisation-led effort to deal with the problem of the capacity of health services through human resources in Africa.

Hilary Benn: At its last gathering, the World Health Assembly passed a resolution asking the WHO to look at that very question and will report back next time. It included the proposal for an international code. Quite what that might say and how it would be enforced I cannot say.

AIDS is having a devastating impact not only on the countries themselves but on the capacity of their health services. That is why we are working with the Government of Malawi, for example, to try to double their health capacity over the next six years. The vacancy rates in Malawi are running at 64 per cent. for nurses, 91 per cent. for obstetricians and gynaecologists and 85 per cent. for surgeons. There are 10 districts in
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Malawi with no Ministry of Health doctor whatever. That is the scale of the challenge, and we are considering a programme that will include external recruitment, to try to sustain the capacity of the Malawian health service.

Mr. Julian Brazier (Canterbury) (Con): Everything that the Secretary of State has said on this issue is welcome, but the fact remains that we are still pillaging doctors and nurses from countries that are desperately short of them; a figure even worse than those that he cited is the 97 per cent. shortfall of nurses in Uganda. Will he ask the Secretary of State for Health to take action, not just to tighten the code of practice, but to ban the NHS from taking staff, through private sector agencies, from the countries with the greatest shortfall of medical and nursing staff?

Hilary Benn: The code of practice says very clearly that there will not be active recruitment. The really difficult question, if we are honest, is this; if an individual from a developing country who is a nurse or a doctor chooses to seek employment in the United Kingdom or the United States of America, is it right to have a law that says that they cannot be employed in any capacity in the health service in our country? The individual would say, "What about my right?" Linking back to the earlier question about remittances, one thing that encourages people to seek employment in another country is that they can earn a higher salary so that they can send back money to help sustain their families. One must be aware of the two sides of the argument. The purpose of the code of practice is to prevent active recruitment, and my right hon. Friend the Health Secretary is investigating what more we can do to deal with the problem.

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